Pneumothorax

Question 1

causes of pneumothorax

Answer 1

• commonly primary spontaneous – young thin men +- smoker
Rupture of subpleural bulla
• Secondary (pre-existing lung disease): Asthma, and COPD are commonest. Others malignancy, CF, trauma, iatrogenic (pleural biopsy)

Question 2

symptoms of simple pneumothorax

Answer 2

maybe asymptomatic
sudden sharp pleuritic chest pain that is made worse by breathing in
shortness of breath (worse if there is underlying disease)

Question 3

Symptoms of tension pneumothorax

Answer 3

sudden onset sharp pleuritic chest pain
increased SOB
one way valve letting air only into pleura not out
immediate intervention needed

Question 4

signs of tension pneumothorax

Answer 4

deviated trachea (away from lesion)
hyperesonant on percussion
absent air sounds on affected sides
mediastinal displacement (heart move away from lesion)
elevated JVP
compression of major veins
tachycarida
hypotenssion

Question 5

signs of simple pneumothorax

Answer 5

if big enough, reduced air sounds, resonant percussion note

Question 6

tension vs simple pneumothorax

Answer 6

in tension there is a one-way valve letting air into pleural space but not out. thus more air inside with each breath –> rapid intervention.

In simple pneumothrax - there is a small tear on the lung that alows movement of air. air pressure equalizes
the tear usually heals within few days and trapped air gradually becomes reabsorbed in lung.

Question 7

Management of simple pneumothorax

Answer 7

percutaneous needle aspiration of air should be made in the first instance (could avoid need of chest drain)

intercostal drain if pneumothorax persists after above
oxygen

Question 8

patients with unresolved pneumothorax should avoid

Answer 8

flying (air entry up with altitude) and smoking

Question 9

where should, intercostal drains with an underwater seal be inserted

Answer 9

4,5,6th ICS in mid axillary line

Question 10

What risks patients with Hx of pneumothorax have

Answer 10

Recurrence 25%

Question 11

when to start surgery for recurrent pneumothorax

Answer 11

provide Surgical pleurodesis, with thoracoscopic pleural abrasion or pleurectomy after second event

Question 12

How to do a perutaneuos chest drain

Answer 12

Large bore cannula and fill partially with 0.9 saline in 2nd ICS just above rib 3 insert and leave to open air IN THE SAME SIDE OF PNEUMO