9.2 - Pneumothorax And Pleural Effusion Flashcards
(35 cards)
What is a pneumothorax?
Air within the pleural cavity
What complications can be caused by a pneumothorax?
Disruption of the pleura (visceral or pleural) -> air flows from higher pressure to lower pressure -> disruption of the balance -> lung collapses.
What is a simple pneumothorax?
Small to moderate size
Haemodynamic stable patient
What is a tension pneumothorax?
Causes haemodynamic instability (tachycardic, hypertensive)
Caused by the one-way flow of air into the pleural cavity causing increase of pressure in the thoracic cavity
What is a primary pneumothorax?
Spontaneous
No underlying lung pathology
What are the risk factors for a primary pneumothorax?
Male
Young
Family history of pneumothorax
Smoking
What is secondary pneumothorax?
Pneumothorax secondary to pre existing lung pathology
What lung pathologies are associated with secondary pneumothorax?
COPD (70%) Asthma Bronchiectasis – inc cystic fibrosis Lung cancer Infections : TB, pneumonia Marfan’s syndrome, Ehler’s Danlos syndrome RA, SLE (systemic lupus erythematosus)
What are the 3 aetiologies of a pneumothorax?
Spontaneous - sub plural bless / bulla (air-filled sacs) burst
Iatrogenic - insertion of central lines (esp to internal JV) / cardiac pacing wires
Trauma - stab wound/ gunshot wound/ rib fracture puncturing visceral pleura
What are the presenting symptoms of a simple pneumothorax?
Chest pain - pleuritic in nature, sudden onset, sharp pain
SOB
History of trauma/lung disease
What are the clinical signs of a simple pneumothorax?
Trachea deviation- Normal
Chest movement - Reduced on affected side
Percussion - Hyper-resonant or resonant on affected side
Auscultation - Reduced/absent on affected side
Vocal/tactile resonance - Reduced on affected side
How does a simple pneumothorax present of a CRX?
Hyper-lucent (ie appear darker)
Absent lung markings
Collapsed lung borders seen
How does a CT of a simple pneumothorax appear?
Absent lung markings
Collapsed lung borders seen
What are the 3 ways of managing pneumothorax?
Conservative treatment
Pleural aspiration
Chest drain
When is conservative treatment for a pneumothorax adequate?
Small pneumothorax
Send home, bring back at later date
See if symptoms resolved and Xray improved
What is pleural aspiration the correct treatment of a pneumothorax?
Maximum amount you can drain = 2.5L
How is a chest drain inserted
By ultrasound guidance
Where is a chest drain inserted?
Safe triangle borders:
Superior: Base of the axilla
Inferior: 6th rib / 5th intercostal space
Anterior: lateral edge of pectoralis major muscle
Posterior: lateral edge of latissimus dorsi muscle
Where does a chest drain drain into?
Underwater seal - allows air to leave pleural cavity but not re-enter.
Why does air move into the pleural space?
As external air pressure is higher than in the pleural cavity
Why is a tension pneumothorax a medical emergency?
As build up of pressure in the thoracic cavity compresses the SVC/IVC.
Blood supply in heart interrupted. Can cause hypotension, tachycardia, cyanosis, and hypoxaemia.
Can lead to cardiac arrest and death
What are the presenting signs and symptoms of a tension pneumothorax?
Similar to simple pneumothorax but also have: Respiratory distress Cyanosis Marked tachycardia Hypoxemia
What are the clinical signs of a tension pneumothorax?
Trachea deviation - Away from the affected side
Chest movement - Reduced on affected side
Auscultation - reduced/absent on affected side
Percussion - hyper resonant or resonant on affected side
Vocal/tactile resonance -reduced on affected side
How do we treat tension pneumothorax?
Emergency needle decompression - needle in pleasurable cavity in the 2nd intercostal space in the mid-clavicular line
