Pneumothorax -Goya Flashcards Preview

Respiratory > Pneumothorax -Goya > Flashcards

Flashcards in Pneumothorax -Goya Deck (19):
1

What is a pneumothorax? What are the 3 types?

when there is an opening on the surface of the lung or airways that allows air to enter the pleural space between the pleura, creating an actual space

Primary spontaneous pneumothorax (PSP), Secondary Spontaneous Pneumothorax (SSP) and tension pneumothorax

2

What causes PSPs?

rupture of sub pleural emphysematous blebs located at the apices

(blebs associated with congenital abnormalities and inflammation of the airways)

strong association between PSP and smoking

pts tend to be tall and thin

3

What are the CXR findings associated with Pneumothorax?

Presence of visceral-pleural line (vertical line)

Deep sulcus sign

Hydropneumothorax (seen in CT--> collapse of lung with air fluid below)

Tension Pneumothorax

4

What are the clinical manifestations and PE findings associated with PSP?

normally develops at rest

peak age is early 20s (rare > 40)

chest pain (to side of pneumo) and dyspnea

decreased chest wall excursion, diminished breath sounds and hyper resonant percussion on the affected side

5

A 29-year-old student is brought to the ED after he is stabbed immediately inferior to the right scapula about the level of T7 with a sharp unknown object. Patient states that during a group discussion a conflict broke out, and the student was stabbed while walking out of the room. His blood pressure is 110/64 mm Hg, heart rate is 116/min, respiratory rate is 20 breaths/min, and oxygen saturation is 92% on 100% oxygen mask. On physical exam the wound is small but seems to bubble with each inspiration and expiration. For your first step you decide to get a CXR, which of the following would be most likely to find on imaging?
(A) Right upper lobe consolidation
(B) Right pneumothorax
(C) Right solitary pulmonary nodule
(D) Right pulmonary embolism

(B) Right pneumothorax

6

What might the ABG for a pneumothorax show?

hypoxemia

hypercapnea

acute reap alkalosis maybe present if pain, anxiety and hypoxemia are bad

7

What is the recurrence rate of a PSP?

52%

8

When is observation recommended for a pneumothorax?

young pt who is asyptomatic and has normal vitals

pneumothorax <15%

9

A 29-year-old student came to the clinic for annual physical exam. His blood pressure is 110/64 mm Hg, HR-90/min, RR 20 breaths/min, and o2 sat 98% on room air. On physical exam he had decreased breath sound on right apex. His chest x-ray shows 5% right apical pneumothorax, which of the following is next best step?
A. Observation
B. Simple Aspiration
C. Tube Thoracostomy
D. Tube Thoracostomy with sclerosing agent
E. Thoracoscopy

A. Observation

10

Who should be treated with simple aspiration?

initial treatment for most PSP > 15% (if stable)

11

A 29-year-old student came to the clinic for shortness of breath. His blood pressure is 110/64 mm Hg, HR-90/min, RR 20 breaths/min, and o2 sat 98% on room air. On physical exam he had decreased breath sound on right apex. His chest x-ray shows 25% right apical pneumothorax, which of the following is next best step?
A. Observation
B. Simple Aspiration
C. Tube Thoracostomy
D. Tube Thoracostomy with sclerosing agent
E. Thoracoscopy

B. Simple Aspiration

12

When should pts be treated with a tube thoracostomy? Does this procedure reduce the risk of reoccurrence?

Failure of simple aspiration or patients that have a recurrent spontaneous pneumothorax

Does not reduce the incidence of recurrence

13

What is the effective treatment for SPS that helps prevent reoccurrence? When is this procedure indicated?

Thoracoscopy (VATS)

indications:
-aspiration fails
-lung remains expanded after 3 days of tube thoracostomy
-bronchopleural fistula persist after 3 days
-recurrent pneumo after chemical pleurodesis
-in an occupation where recurrence is dangerous (airline pilot)

14

What is SSP normally seen in?

COPD

Symptoms are more severe than PSP*
--> Less pulmonary reserve, so any decrease in pulmonary function is more noticeable

ABG more abnormal in SSP than PSP


15

How is diagnosis of SSP established?

demonstrating the visceral pleural line (hard to see in hyper inflated COPD)

16

How is SSP treated in COPD?

Treatment options are same as PSP, but aspiration is less likely to successful


recurrence rates for pneumothorax in COPD is higher than PSP

17

What is the pathophysiology of a tension pneumothorax?

inc intrapleural P --> compress lung to other side --> compress against trachea, heart, aorta and esophagus, --> ventilation and CO compromised

18

What will the clinical manifestations be with a tension pneumothorax?

Severe Dyspnea

Tracheal Deviation

Decreased Cardiac Output

Distended Neck Veins

inc RR, pulse, dec blood pressure

Shock

19

What is the medical treatment for a tension pneumothorax?

emergency!

supplemental O2 to prevent hypoxemia

large bore needle into pleural cavity to decompress lung

tube thoracostomy