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Flashcards in Pleural Disease Deck (26):
1

What are the different types of pneumothorax?

Spontaneous (primary without lung disease, secondary with lung disease)
Traumatic
Tension
Iatrogenic

2

What are the risk factors for pneumothorax?

Pre-existing lung disease
Height
Smoking/cannabis
Diving
Trauma/chest procedure
Association with other conditions e.g. Marfan's syndrome

3

How is pleural fluid formed?

It is produced by capillary filtration at the parietal pleura

4

What is meant by a pleural effusion?

Any collection of fluid within the pleural space

5

What is meant by chylothorax?

Lymphatic fluid within the pleural cavity

6

What is meant by haemothorax?

Blood within the pleural cavity

7

What is meant by empyema?

Pus/infected fluid within the pleural space

8

What is meant by a transudate?
What are some of the causes of a transudate?

Fluid with a low protein content less than 30g/L
Increased hydrostatic pressure in heart failure
Decreased capillary oncotic pressure in liver failure
Increased capillary permeability in sepsis

9

What is the management of a transudate effusion?

Treat the underlying cause
If effusion resolves, stop or reduce treatment
If effusion persists, then therapeutic aspiration/drainage is required
Percuss the meniscus, and go 1-2 ICS below

10

What is meant by an exudate?
What are some of the causes of an exudate?

Fluid with a high protein content greater than 30g/L
Neoplasms, infection (TB, HIV), immune disease and abdominal disease (e.g. Pancreatitis)

11

What is Light's criteria?

If pleural fluid protein level between 25 and 35g/L (I.e. Borderline), exudate if one of the following:
Pleural fluid/serum protein >0.5
Pleural fluid/serum LDH >0.6
Pleural fluid LDH >2/3 of the upper limit of normal

12

How is pleural fluid reabsorbed?
What factors decrease the reabsorption of pleural fluid?

Lymphatic drainage
Decreases if there is lymphatic blockage or elevated systemic venous pressure

13

What is meant by a pneumothorax?

Air in the pleural cavity
(Due to a break in the integrity of the pleural seal)

14

What is involved in the diagnosis of a pleural effusion?

Examination
CXR
Ultrasound guided pleural aspiration (biochemistry, cytology, microbiology)

15

What are the signs of a tension pneumothorax?

Hypotension, tachycardia, SOB
Hyperresonnant, no breath sounds, tracheal deviation, mediastinal shift

16

What is the management of a tension pneumothorax?

Large bore IV cannula into 2nd ICS MCL
Chest drain in to the affected side
Xray

17

What are the signs of a spontaneous pneumothorax?

Ipsilateral reduced expansion
Hyper-resonant on percussion
Reduced air entry
Diminished breath sounds
(May be tachycardia, tachpneoa, cyanosis, accessory muscles)

18

What are the indicators for a surgical referral in pneumothoraces?

Second ipsilateral
Bilateral
Persistent air leak despite 7/7 of drain
Pregnant
High risk profession
Spontaneous haemothorax

19

What advice should be given to patients following a pneumothorax?

Avoid air travel 7/7
Avoid diving
Smoking cessation

20

What is the risk of applying suction to a chest drain?

Re-expansion pulmonary oedema

21

What investigations/checks need to happen following the insertion of a chest drain?

Regular obs, wound site, volume/colour of fluid drained, swinging/bubbling activity, RR and sats
Repeat CXR: to assess postion of the drain, any iatrogenic damage, and success of chest drain insertion

22

What are the complications of chest drain insertion?

Bleeding
Infection
Drain failure
Iatrogenic damage
Damage to the neurovascular bundle
Pain

23

What are the different methods of chest drain insertion?

What are their indications?

Seldingertechnique - primary/iatrogenic pneumothorax, pleural effusion, empyema

Open/Blunt technique - traumatic chest injury pneumothorax/haem/both or for the drainage of thick mucous fluid (under USS)

23

What are the borders of the triangle of safety?

Lateral border of pectoralis major
Lateral border of latissimus dorsi
Base of axillary
Line of the 5th ICS

23

What are the BTS guidelines in the management of a primary spontaneous pneumothorax?

If breathless/>2cm air rim - aspirate
If aspiration fails, or still breathless or air rim persists - consider chest drain
If not breathless or air rim less than 2cm - consider discharge with OP CXR

23

What are the BTS guidelines in the management of a secondary spontaneous pneumothorax?

Air rim >2cm or breathless - chest drain
If 1-2cm or not breathless - consider aspiration - if fails - chest drain
If less than 1cm - admit for 24hours for observation and oxygen