pneumothorax

Question 1

Causes

Answer 1

Primary: Spontaneous- in young, tall and thin
Secondary:
previous disease: COPD, TB, Pneumonia, Asthma, CF
Traumatic:
Iatrogenic: caused by medical treatment e.g
-pleural aspiration
-liver, lung, breast and renal biopsy
-acupuncture
Non-Iatrogenic:
Blunt chest wound e.g. broken rib
Penetrating chest wound e.g. stabbing

Question 2

Signs

Answer 2

-Potential surgical emphysema
If tension:
-Trachea will move away from affected side
If no tension: 
-Trachea will move towards affected side
-Reduced chest expansion
-Hyper resonant vocal sounds

Question 3

Symptoms

Answer 3

Could be asymptomatic if small

• Pleuritic chest pain
• Breathlessness

Question 4

Treatment depending on type of pneumothorax

Answer 4

If primary- no breathlessness:

• CXR + observation for 24 hours
• CXR 24 hours later- should resolve in 1.25% of a day

If primary- breathless:

• cannula with lignocaine , then drain at 2nd intercostal space mid-clavicular
• drain until venflor feels tip of the lungs
• CXR 24 hours later

If secondary- breathless:

• difficult to aspirate
• chest drain 4th intercostal mid-clavicular

If it does not resolve in 3 days- contact thoracic surgeon- thorascopy of visceral pleura for tears

Question 5

How to carry out an intercostal chest drain

Answer 5

1- lung inflates after 1-2 days
2-bubbling at drain will stop
3- 2 options:
-clamp drain- CXR 24 hours- no change-remove drain
-CXR after 24 hours, remove

Question 6

Tension pneumothorax: what is it

Answer 6

• emergency medicine
• One way air valve into the pleural cavity
• air pushed into the pleural space on inspiration but does not leave

Question 7

signs which are characteristic of tension pneumothorax

Answer 7

• contralateral tracheal deviation
• increase JVP
• tachycardia
• hypoxia

Question 8

signs of Non-tension pneumothorax

Answer 8

• trachea moves towards the affected side
• decreased chest expansion
• absent or reduced breath sounds
• hyper-resonant

Question 9

What equipment is needed to aspirate a pneumothorax?

Answer 9

-Venflor with lignocaine and three taps

-

Question 10

Definition

Answer 10

The presence of air in the pleural space due to a breach in the parietal layer of the pleura which leads to collapse of the lung due to the elastic recoil properties of the lung

Question 11

Outcomes of an ideal chest drain

Answer 11

Lung inflates again in 1-2 days
The drain stops bubbling
CXR confirms the lung has re-inflated
1- re XRAY after 24 hours- if no change then discharge
2-clamp drain for 24 hours- re Xray- if no change then discharge

Question 12

Outcomes for less than ideal drainage

Answer 12

Lung fails to re-inflate
Drain continues to bubble
After 3 days a surgeon must be Called to perform a thorascopic examination of the lungs

Question 13

Surgical management

Answer 13

Pleurodesis- ablation of the pleura.

Pleurectomy- part of the pleura is removed

Question 14

When is Pleurodesis performed?

Answer 14

• Secondary ipsilatery pneumothorax
• Primary- Bilateral
• Primary contralateral
• First pneumothorax in patients who have high risk occupations

Question 15

Contralateral

Answer 15

symptoms in opposite side of body to side which is affected

Question 16

Pleural aspiration vs chest drain

Answer 16

Pleural aspiration- when small <2cm rim

Chest drain- when larger >2cm rim