Pneumothorax, Respiratory Failure

Question 1

What is respiratory failure?

Answer 1

Inability to meet adequate blood oxygen levels

Question 2

What is the O2 and CO2 in type 1 and type 2 respiratory failure

Answer 2

Type 1 low O2, normal/low CO2

Type 2 low O2, high CO2

Question 3

What investigation differentiates type 1 and 2 respiratory failure?

Answer 3

ABG

Question 4

What type of respiratory failure is due to a VQ miss match?

Answer 4

Type 1

Question 5

Name 4 causes of Type II respiratory failure

Answer 5

COPD, drug overdose, sleep apnoea, neuromuscular disease e.g. myasthenia

Question 6

What type of respiratory failure would are PE cause?

Answer 6

Type 1

Question 7

What type of respiratory failure with pulmonary fibrosis cause ?

Answer 7

Type 1

Question 8

What type of respiratory failure would pulmonary edema cause?

Answer 8

Type 1

Question 9

Obesity hypoventilation syndrome is also known as what?

Answer 9

Pickwickian syndrome

Question 10

Early morning headache, daytime somnolence, nocturnal hypoventilation, hypercapnia, episodes of snoring followed by upper airway obstruction and apnoea are all features of what disorder

Answer 10

Obesity hypoventilation syndrome

Question 11

What rate of oxygen delivery should be used in Type II respiratory failure?

Answer 11

24% oxygen

Question 12

“Non-cardiogenic pulmonary oedema leading to acute respiratory failure” is the description of what?

Answer 12

Acute respiratory distress syndrome AKA acute lung injury

Question 13

Dobutamine and nitric oxide are used in the management of ARDS, what type of drug is dobutamine, what type of drug is nitric oxide?

Answer 13

Dobutamine is an inotrope and nitric oxide is a vasodilator

Question 14

In ARDS, PaO2 <60 or PaCO2 >45 are both indications for what?

Answer 14

Indications for mechanical ventilation

Question 15

What type of ventilation is first line in the management of acute respiratory distress syndrome?

Answer 15

Non-invasive ventilation

Question 16

What is a pneumothorax?

Answer 16

Air in the pleural cavity

Question 17

What is a respiratory complication of mechanical ventilation?

Answer 17

Iatrogenic pneumothorax

Central line placements and lung biopsies can also cause iatrogenic pneumothorax

Question 18

What is the chest x-ray appearance of a pneumothorax?

Answer 18

Absent lung markings over an area

Question 19

Are cannabis, Marfan’s syndrome and tall thin body types associated with primary or secondary pneumothorax

Answer 19

Primary

Symptoms are minimal/ absent compared to secondary

Question 20

What is the presentation of a pneumothorax?

Answer 20

Sudden onset pain +- SOB
Appear distressed, sweating, >HR
Reduced breath sounds + hyperresonant percussion over area

Question 21

Secondary pneumothorax due to underlying lung disease, true or false

Answer 21

True

Question 22

What are the three options for the management of a pneumothorax?

Answer 22

Observation, needle aspiration, chest drain

Question 23

Where is a chest drain inserted?

Answer 23

4th/5th intercostal space midaxillary

Question 24

Does the trachea deviate away from or towards a tension pneumothorax?

Answer 24

Away from

Question 25

What is pulsus paradoxicus?

Answer 25

Pulse slows on inspiration

Question 26

Where is the needle inserted in emergency needle decompression for a tension pneumothorax?

Answer 26

2nd or 3rd intercostal space midclavicular line

Question 27

In the Mx of pneumothorax, the 1st line Mx depends on what factors?

Answer 27

Size >2cm and or breathless

Question 28

If a primary pneumothorax is >2cm and /or breathless what is the mx? what if <2cm or not breathless

Answer 28

Aspirate 16-18G cannula
If successful consider discharge and OPD review in 2-4wk
If still breathless do chest drain + admit

If not breathless/<2cm consider discharge and OPD review in 2-4wk

Question 29

If a secondary pneumothorax is >2cm and /or breathless what is the mx? what if sized 1-2cm?

Answer 29

Admit all
>2cm/SOB = chest drain size 8-14Fr

1-2cm = aspirate 16-18G cannula. if size remains 1-2cm chest drain

<1cm = high flow O2 + observe

Question 30

Can a tension pneumothorax cause a raised JVP?

Answer 30

Yes