1
Q
ESSENCE
A
Air trapped into pleural space, seperating the lungs from the chest wall
2
Q
AETIOLOGY
A
- Spontaneous
- Trauma
- Iatrogenic
- Lung pathologies - infection, asthma, COPD
3
Q
INVESTIGATIONS
First choice and second
A
- 1) Chest x-ray
- 2) CT thorax if too small to see on x-ray
4
Q
INVESTIGATIONS
How do you measure size
A
Measure horizontally from lung edge to inside of chest wall at level of hilum
5
Q
MANAGEMENT
Acute management
A
- If no shortness of breath and <2cm rim of air on x-ray
- No treatment as resolves spontaneously
- Follow up 2-4 weeks
- If shortness of breath and./or >2cm of air on x-ray
- Aspiration followed by reassessment
- When aspiration fails twice, chest drain
- If unstable, bilateral or secondary generally requires chest drain
6
Q
MANAGEMENT
Where are chest drains inserted
A
- In triangle of safety
- 5th intercostal space (inferior nipple line)
- Mixaxillary line (lateral edge of latissimus dorsi)
- Anterior axillary line (lateral edge of pectoral major)
7
Q
MANAGEMENT
Why is needle inserted above rib
A
Avoid neurovascular bundle below rib
8
Q
MANAGEMENT
How do you know when chest drain is no longer needed
A
No further bubbling in drain bottle
9
Q
MANAGEMENT
2 chest drain complications
A
- Air leaks
- Surgical emphysema (also called subcutaneous emphysema)
10
Q
MANAGEMENT
Surgical management indications
A
- Chest drain fails
- Persistent air leak in drain
- Pneumothorax reccurs (recurrent pneumothorax)
11
Q
MANAGEMENT
Surgical options
A
- Done using video-assisted thoracoscopic surgery (VATS)
- Abrasive pleurodesis (direct physical irritation of pleura)
- Chemical pleurodesis (chemical irritation of pleura)
- Pleurectomy (removal of pleura)
12
Q
MANAGEMENT
What is pleurodesis
A
- Creating inflammatory reaction in pleural lining so pleura stick together and pleural space becomes sealed
Y4 - Surgery - Cardiothoracic
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Decks in class (12)
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