Pulm. Pneumotorax (10-28) (2)

Question 1

UW. Spontaneous. there are primary and secondary. primary assoc with what?

Answer 1

No preceding event or lung disease; thin, young male

Question 2

UW. Spontaneous. there are primary and secondary. secondary assoc with what?

Answer 2

Underlying lung disease, eg COPD

Question 3

UW. Tension. assoc with what?

Answer 3

LIFE THREATENING

Often due to trauma or mechanical ventilation

Question 4

UW. Spontaneous. signs and symptoms?

Answer 4

Chest pain, dyspnea

Decr. breath sounds, decr. chest movement

Ipsilateral hyperresonance to percusion

Question 5

UW. Spontaneous. what percusion?

Answer 5

Ipsilateral hyperresonance to percusion

Question 6

UW. Tension. signs and symptoms?

Answer 6

same as in spontaneous +
a) HEMODINAMIC INSTABILITY
b) tracheal deviation away from affected side

Question 7

UW. Spontaneous. Imaging? 2

Answer 7

Abscent lung markings
Visceral pleural line

Question 8

UW. Tension. Imaging? 2+2

Answer 8

same as in spontaneous+
a) contralateral MEDIASTINAL SHIFT
b) Ipsilateral hemidiaphragm flattening

Question 9

UW. Spontaneous. Management? small

Answer 9

small =< 2 cm.
Observation and oxygen

Question 10

UW. Spontaneous. Management? large and stable

Answer 10

Needle aspiration or chest tube

Question 11

UW. tension. Management?

Answer 11

URGENT needle decompresion or chest tube placement

Question 12

UW. what sign may be supportive for pneumothorax?

Answer 12

Increased brightness on transillumination of the chest is supportive of the diagnosis.

Question 13

UW. tension. causes?

Answer 13

CVK!!!!

Question 14

UW. tension. what worsens?

Answer 14

positive pressure ventilation

Question 15

UW. tension. why impaired cardio function?

Answer 15

Air within the pleural space that displaces mediastinal structures and compromises
cardiopulmonary function.

Question 16

UW. tension. clinical?

Answer 16

SOB
tachycardia
tachypnea
hypotension
neck vein distension

Question 17

UW. tension. If HD stabe or unsure –> imaging

Answer 17

.

Question 18

UW. tension. treatment. if unstable HD?

Answer 18

Needle thoracostomy in hemodynamically unstable.

Question 19

UW. tension. treatment. Needle thoracostomy place?

Answer 19

2nd left intercostal space along midclavicular line

Question 20

UW. tension. treatment. needle followed by emergency tube thoracostomy. what place?

Answer 20

Fifth intercostal space in the midaxillary line.

Question 21

UW. tension. treatment. needle –> tube – next point buvo sitas:
This is an important exception to the typical order or ABC but is necessary
because PPV rapidly increases accumulated air and intrathoracic pressure –> exacerbating TP and cardiovascular collapse.

Answer 21

.

Question 22

UW. Spontaneous. other risk apart young/tall men?

Answer 22

smoking, Marfan, thoracic endometriosis

Also: secondary to lung disease (COPD, CF)

Question 23

UW. Spontaneous. clinical?

Answer 23

SOB, hypoxia, unilateral breath sounds, chest pain, hyperresonance on percussion

Question 24

UW. Spontaneous. Management depends on size of the lesion and clinical status

Answer 24

.

Question 25

UW. Spontaneous. small treatment?

Answer 25

Clinically stable patients with small pneumothoraces: supplemental oxygen; it resolves spontaneously.

Question 26

UW. Spontaneous. large and stable treatment?

Answer 26

Large pneumothoraces in stable patient: get decompressed with a large bore needle inserted in the 2nd or 3rd IC space midclavicular or 4th or 5th IC space midaxillary.

Question 27

UW. Spontaneous. large and HD NONstable treatment?

Answer 27

Hemodynamically unstable should get emergency tube thoracotomy. ● If not available --> urgent needle decompression.

Question 28

UW. Spontaneous. treatment. If lungs fail to adequately re-expands (e.g., <90% expansion) and a persistent air leak is present, placement of a one-way valve, creation of a blood patch, or VATS can be used.

Answer 28

.

Question 29

UW. Spontaneous. treatment. if recurrent -->

Answer 29

Recurrent VATS pleurodesis or chemical (e.g., tetracycline derivative, talc) pleurodesis can be performed.