January 11, 2016 - Pneumothorax Flashcards Preview

COURSE 3 > January 11, 2016 - Pneumothorax > Flashcards

Flashcards in January 11, 2016 - Pneumothorax Deck (14):
1

Chest Discomfort Scheme

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2

Acute Dyspnea Scheme

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What is a Pneumothorax?

When air becomes trapped between the visceral and parietal pleura in the lungs.

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Signs and Symptoms of Pneumothorax

Chest pain

Dyspnea

Tachycardia

Hypoxia

Hyperresonance (full of air)

Tracheal shift (if big and collapses lung)

Asymptomatic

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Diagnosis of Pneumothorax

Chest-Xray

Notice the areas of hyperlucency.

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Classification of Pneumothorasx

Primary - spontaneous with no underlying disease

Secondary - have an underlying disease such as COPD, pulmonary fibrosis, HIV

Iatrogenic - we did this... often when placing a subclavean catheter or pacemaker wire

Traumatic - often in conjunction with a rib fracture

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Primary Pneumothorax

Spontaneously occurs.

Has high recurrence rates of about 30-40% after the first presentation, and about 50% after the second presentation.

Never allowed to scuba dive.

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Risk Factors for Primary Pneumothorax

Tall

Slim

Male

Younger age

Smoker

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Management of Pneumothorax

1. Ensure patient stability - ABCs and oxygen

2. Management of air in the pleural space

3. Prevent recurrence

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Management of Pleural Air

Serial observation

Supplemental oxygen

Aspiration

Chest tube

Needle decompression

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When to Treat Pneumothorax

You must treat pneumothorax when...

It is symptomatic and large primary pneumothorax (>2-3cm... This will reduce lung volume by up to 50%)

Tension pneumothorax

Secondary pneumothorax

Patient is experiencing breathlessness

12

When to Remove a Chest Tube

#1 - when the air has been evacuated (lung is up on CXR)

#2 - when there is no more air leaking out. Often you will clamp the lung shut for 2-4 hours and do a repeat CXR.

13

Tension Pneumothorax

When the intrapleural pressure exceeds atmospheric pressure. This occurs because of essentially a one-way valve on inspiration where air continues to get into the pleural space. This pushes the mediastinum to the opposite side.

This is a medical emergency.

This needs to be decompressed with a large bore needle in the 2nd intercostal space and afterwards a chest tube and waterseal placed.

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14

Bullectomy

A surgical procedure to remove a bulla or bleb.

A when these bullae or blebs rupture, it can cause a primary pneumothorax.

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