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YR6: RESPIRATORY > Pneumothorax > Flashcards

Pneumothorax Flashcards

1
Q

What is pneumothorax?

A

air in the pleural cavity (between lung + chest wall) resulting in collapse of the lung on the affected side

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2
Q

Describe the aetiology of spontaneous pneumothorax

A

Occurs in young, healthy people
Typically in tall, thin males
Probably caused by rupture of a subpleural bleb

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3
Q

What are 2 variants of pneumothorax?

A

Haemothorax: blood
Chylothorax: lymph

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4
Q

Describe the aetiology of secondary pneumothorax

A

Occurs in patients with pre-existing lung disease (e.g. COPD, asthma, TB)

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5
Q

Describe the aetiology of traumatic pneumothorax

A

Caused by penetrating injury to the chest e.g. stab wound
Often iatrogenic

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6
Q

List 7 iatrogenic pneumothorax

A

Mechanical ventilation with high PEEP
NIV
Hyperbaric O2 therapy
Thoracocentesis
Central line placement
Bronchoscopy
Lung biopsy

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7
Q

Which types of pneumothorax can lead to a tension pneumothorax?

A

Any

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8
Q

Which structural disorders predispose to pneumothorax? Give 2 examples

A

Collagen disorders
Marfan’s syndrome
Ehlers-Danlos syndrome

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9
Q

What is the most important risk factor for pneumothorax?

A

Smoking
Increases risk 22-fold in M + 9 fold in F

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10
Q

List 5 non-modifiable risk factors for primary pneumothorax

A

FH
Male
Young
Slim + tall stature
Homocystinuria

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11
Q

Describe 2 symptoms of pneumothorax

A

Acute onset pleuritic chest pain
SOB

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12
Q

Give 4 signs on examination of pneumothorax on examination

A

Reduced chest wall movement
Absent breath sounds
Hyper-resonant percussion
Reduced vocal fremitus

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13
Q

Why may symptoms be more severe in secondary pneumothorax?

A

Pre-existing lung disease means they already have reduced pulmonary reserves

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14
Q

What 4 signs of tension pneumothorax may be found on examination?

A

Severe acute respiratory distress: cyanosis, restlessness, diaphoresis
Distended neck veins
Haemodynamic instability: Tachycardia, Hypotension, pulses paradoxus
Tracheal deviation AWAY from side of pneumothorax

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15
Q

What additional 3 signs of tension pneumothorax may be found in ventilated patients?

A

Rapid decrease in SpO2
Reduced air flow
Increased ventilation pressure

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16
Q

What is the primary investigation for pneumothorax?

A

PA CXR

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17
Q

What is seen on CXR in pneumothorax?

A

Visible rim between lung margin + chest wall
Absence of lung markings between lung margin + chest wall

18
Q

What is seen on CXR in tension pneumothorax?

A

Lung completely compressed
Trachea PUSHED AWAY
Mediastinal shift AWAY
Hemidiaphragm depression

19
Q

In patients unable to sit upright, what imaging may be considered?

A

USS
CT

20
Q

What is an indication to perform an ABG in a patient with pneumothorax?

A

in patients with SpO2 <92% on RA

21
Q

Describe the immediate management for a tension pneumothorax

A
  1. Cardiac arrest call
    Immediate decompression:
    Insert large bore cannula into 2nd ICS MCL- hiss of air
    High flow O2
  2. Insert chest drain once decompressed + regular analgesia
22
Q

How does management of tension pneumothorax secondary to trauma differ?

A

Decompression with open thoracostomy

23
Q

What is considered ‘minimally symptomatic’ in primary spontaneous pneumothorax? How should this be managed?

A

No significant pain
No breathlessness
No physiological compromise
If minimally symptomatic conservative Mx regardless of size

24
Q

What is conservative management for a minimally symptomatic primary pneumothorax?

A

Observation 4-6h
Supplemental O2
Regular review as OP every 2-4 days

25
Q

How should a symptomatic small <2cm primary pneumothorax be managed?

A

Needle aspiration

26
Q

How should a large >2cm primary pneumothorax be managed?

A

Needle aspiration
Observe 4-6h
If unsuccessful; chest drain + admit

27
Q

How should aspiration be performed?

A

Aspirate up to 2.5L
Use 16-18G cannula

28
Q

How should a small secondary pneumothorax be managed?

A

Admit + observe 24h
High flow O2

29
Q

How should a moderate secondary pneumothorax be managed?

A

Needle aspiration
High flow O2
Admit + observe 24h

30
Q

How should a large/ symptomatic secondary pneumothorax be managed?

A

Admit
Chest drain
High flow O2

31
Q

In which 3 situations may a Chest Drain with Underwater Seal be performed for primary pneumothoraces? How?

A

Aspiration fails
Fluid in the pleural cavity
Post-decompression of a tension pneumothorax

Inserted in 4th-6th ICS MAL

32
Q

After excluding tension pneumothorax, what is the aim of management? How is this achieved? What influences this decision?

A

To relieve dyspnoea.
Simple observation, needle aspiration + chest drain
Choice depends upon the severity of the condition

33
Q

What does the immediate management of pneumothorax involve?

A

Supplemental Oxygen to relieve hypoxia + accelerate resorption of the pneumothorax

34
Q

What surgical management can be used for recurrence prevention of Pneumothoraces?

A

Refer for Video assisted thoracoscopic surgery (VATS) to perform:
Mechanical/ chemical pleurodesis +/- bullectomy

35
Q

What is a bullectomy?

A

Large fluid filled spaces in the lung (Bullae) are removed to decrease risk of PTX
Performed during VATS

36
Q

Give 3 examples of indications for surgical intervention for prevention of pneumothorax recurrence

A

Severe COPD + significant decompensation with PTX

Tension pneumothorax

High risk occupations: pilots, divers, military

37
Q

Give 2 pieces of advice to a patient who has had a pneumothorax

A

Avoid air travel until 1w post CXR check / 2w after successful drainage if no residual air

Avoid diving indefinitely

38
Q

What is the prognosis for a pneumothorax patient?

A

After having 1 pneumothorax, >,20% will have another
Frequency increases with repeated pneumothoraces

39
Q

What complications may arise in a pneumothorax patient?

A

Recurrent pneumothoraces
Bronchopleural fistula

40
Q

What is the lifetime risk of pneumothorax in a healthy smoker vs non smoker?

A

Smoker 10%
Non-smoker 0.1%

41
Q

What is a complication of rapid decompression pneumothorax?

A

Re-expansion pulmonary oedema

42
Q

How does re-expansion pulmonary oedema present?

A

Asymptomatic radiographic changes to complete cardiopulmonary collapse
Acute onset dyspnoea
Cough
Hypoxaemia
Signs unilateral to PTX (unlike HF)

YR6: RESPIRATORY (38 decks)

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