Flashcards in Pneumothorax Deck (23)
What can cause pneumothorax?
Can be spontaneous (esp in thin young men), chronic lung disease, infection, trauma, iatrogenic, carcinoma, connective tissue disorders such as mar fans syndrome
What are the classifications of pneumothorax?
Spontaneous primary and secondary, trauma
What is a primary spontaneous pneumothorax
Rupture of sub pleural bleb (air sac at apices of lung) which allows air from lungs into pleural cavity. There is no evidence of any underlying causative disease
What is a secondary spontaneous pneumothorax
Underlying lung disease that causes perforation of pleura
Name the two most common symptoms
Sudden unilateral pleuritic pain and/or breathlessness
Which genda tend to be more susceptible
Secondary spontaneous pneumothorax tends to occur in what group of people?
Males over 55
A larger pneumothorax (>15% of hemidiaphragm) may result in what upon auscultation?
Absent breath sounds
What is a tension pneumothorax?
Where the airway and pleural space act as a one way valve causing air to enter but cannot leave resulting in pressures far greater than atmospheric in the pleural cavity causing mediastinal displacement
What does the tension pneumothorax result in?
Rapidly progressive breathlessness, tachy, hypotension due to vena cava kinking, cyanosis, tracheal displacement
When might a tension pneumothorax not result in a mediastinal shift?
When due to malignancy as scarring splints the mediastinum in place
What is a closed pneumothorax
When the communication of air between the two areas stops and lung stays deflated
What is good about a closed pneumothorax?
The pleural pressure remains mean negative and over a few days re-inflates itself and infection is uncommon
What can happen in a open pneumothorax?
Infection can enter the pleural cavity
What is the key investigation?
Management if lung edge less than 2 cm from chest wall without SOB
Usually resolves itself and therefore consider discharge
If the patient suffers a spontaneous pneumothorax and is young how would you treat?
Needle aspiration which avoids the need for a chest drain. If this fails retry and if this fails give chest drain
How would you treat a secondary spontaneous pneumothorax?
Intercostal chest drain in mid axillary line at ICS 4 or 5 or 6
When should you remove the chest drain
24 hours after lung re-inflates
When should surgery be done
If there is bubbling in water after 5-7 days for pleuradhesion
What should people with a closed pneumothorax NOT do for a few weeks
Fly, closed air expands at low pressures of high altitude
When else might you do a pleurodesis?
If pneumothorax recurs