Differentiate a tension pneumothorax from a large pneumothorax
Tension pneumothorax features haemodynamic instability (hypotension, tachycardia)
State the causes of a tension pneumothorax
Rib fracture Mechanical ventilation Failed central venous cannulation
Outline signs seen in tension pneumothorax
Respiratory distress Tachycardia Hypotension Raised JVP Tracheal shift Hyper resonant percussion Reduces breath sounds
Describe the urgent treatment of a tension pneumothorax
Temporary: Large bore needle with saline, or cannula decompression in 2nd intercostal space MCL of affected side. Definite: Chest drain
What is the triangle of safety?
Anatomical landmark for the insertion of chest drains.
- Superior: base of axilla
- Anterior: lateral edge of pectoralis major
- Posterior: anterior border of latissimus dorsi
- Inferior: horizontal line at level of nipple
Define massive haemoptysis
>240ml/24hr, or >100ml/24hr over consecutive days
What key questions should you ask if massive haemoptysis is suspected?
Nature and volume of haemoptysis Weight loss Drug Hx Smoking
List the commonest causes of massive haemoptysis
TB Bronchiectasis Carcinoma
List causes of massive haemoptysis
- Respiratory: infection, bronchiectasis, carcinoma - Cardiovascular: PE, ruptured aortic aneurysm, pulmonary oedema - Coagulation disorders: Drugs^, inherited conditions* - Trauma - Vasculitis (granulomatosis with polyangiitis) and Good pasture's ^ NSAIDs, Anticoagulants, Antiplatelets * Von Willebrands disease (vWF deficiency) and haemophilia
What is the key investigation and treatment of massive haemoptysis?
Ix: CT angiogram Tx: Embolism or ligation
When is a CT angiogram contraindicated?
Renal failure Contrast allergy
What would an empyema feature on aspiration?
Yellow turbid fluid pH <7.2 Low glucose High LDH