Pneumothorax Flashcards
Pneumothorax
Air gets into pleural space separating lung from chest wall
Can occur spontaneously or secondary to trauma, medical interventions or lung pathology
Risk factors
Pre-existing lung disease
Connect tissue disease (Marfan’s, rheumatoid arthritis)
Ventilation (including non-invasive)
Catamenial pneumothorax
Catamenial pneumothorax
3-6% of spontaneous pneumothoraces in menstruating women
Caused by endometriosis within thorax
Symptoms
Dyspnoea
Chest pain (often pleuritic)
Sweating
Tachypnoea
Tachycardia
Investigations
Erect chest xray
Absence of lung markings
CT thorax can detect small pneumothorax too small to be seen on xray
Management
No SOB and <2cm rim of air
- no treatment required
- resolves spontaneously
- follow up in 2-4 weeks
SOB and/or >2cm rim of air
- aspiration and reassessment
If aspiration fails twice
Need chest drain
Management of unstable patients
Or bilateral or secondary pneumothoraces
Require chest drain
Tension pneumothorax
Chest wall creates a one-way valve that lets air in but not out of pleural space
During inspiration air drawn in and during expiration trapped
Creates pressure in thorax, pushes mediastinum across, kink big vessels and cause cardiorespiratory arrest
Signs of tension pneumothorax
Tracheal deviation away from side of pneumothorax
Reduced air entry to affected side
Increased resonant to percussion on affected side
Tachycardia
Hypotension
Management of tension pneumothorax
Insert large bore cannula into second intercostal space in midclavicular line
Once pressure is relieved then a chest drain required for definitive management
Chest drains placement
Triangle of safety
Just above rib to avoid neurovascular bundle that runs below rib
Chest xray to check positioning
Triangle of safety
5th intercostal space (inferior nipple line)
Mid axillary line (lateral line of latissimus dorsi)
Anterior axillary line (lateral edge of pec major)
