Pneumothorax (PTX) Flashcards Preview

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Flashcards in Pneumothorax (PTX) Deck (16)
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1
Q

What is a pneumothorax and what types are there?

A

A breach in the pleura leadin to air fillin the cavity and the lung collapsing on elastic recoil.

Spontaneous - Primary & secondary
Traumatic - Iatrogenic & non-iatrogenic

Any can be tension PTX, where the hole acts like a valve and air can enter but not leave so progressive worsening of symptoms, mediastinal shift and crushing of other lung/heart/trachea

2
Q

How does a primary spontaneous PTX most often occur?

A

Due to the wieght of the lung causing apical blebs which eventually burst
Mainly in young, tall, thin men

3
Q

What lung disease most often causes a secondary spontaneous PTX?

A

COPD causes 30-50% of them

4
Q

What procedures can cause an iatrogenic traumatic PTX?

A

Subclavian Vein Cannulation
Lung,Liver,Renal & breast biopsies
Pleural Aspiration or Biopsy
Acupuncture

5
Q

What causes a non-iatrogenic traumatic PTX?

A

A penetrating injury such as stab or gunshot

A blunt injury that either breaks ribs or ruptures bronchi

6
Q

What are the symptoms of a PTX?

A

If small & the persons lungs are healthy can be asymptomatic
Otherwise acute SOB & pleuritic Pain
Extreme SOB suggests a tension PTX or existing lung disease

7
Q

What are the signs of PTX?

A

Affected Side:

  • Lower breath sounds & expansion
  • Hyperresonance
  • Trachea deviates to affected side

Tension:

  • Haemodynamic compromise
  • Raised JVP
  • Mediastinal shift
  • Trachea deviates away from affected side

Surgical Emphysema if large (bubble wrap like air tracking in subcutaneous fat)

8
Q

How do you asses a PTX?

A

Give that man a CXR

need to decide if its primary or secondary, how big, how Short of breath and if its tension.

9
Q

How do we treat a tension PTX?

A

Needle aspiration and follow with an intercostal chest drain

10
Q

How do we treat a small primary PTX, i.e. when theres no SOB?

A

Observe overnight then re CXR.
If no change then the holes sealed
Send home, no vigourous activity and re-CXR in 2 weeks
HEals super slow

11
Q

How do we treat a breathless primary PTX?

A

Needle Aspiration
If successful overnight -> re-CXR -> send home.
If fails -> Chest drain

12
Q

How do we treat a secondary PTX?

A

Can try to aspirate if small but almost always need a chest drain

13
Q

How do we do needle aspiration?

A

Put a needle then a cannula in the 2nd intercostal space in mid clavicular line.
Success -> Lung surface expands to touch cannula
Failure -> Aspirate over 3 litres (leak is persitant) -> Chest Drain

14
Q

How do we perform a Chest Drain and what do we do if its successful/fails?

A

Drain in 5th intercostal space in mid-axillary line.
Ideal:
-> Lung inflates in 1-2 days & drain stops bubbling.
-> Confirm on a CXR
-> Clamp for 24 hours, Re-CXR, Send home

Non-Ideal:

  • > Fails to ifnlate >48hrs
  • > Apply suction for 24 hours
  • > Call thoracic surgeon for thorascopic inspection
  • > Clip any blebs or tears and maybe talc poudrage pleurodhesis
15
Q

In what cicumstance would we perform surgical or talc poudrage pleurodhesis in order to prevent future PTX?

A

If:

  • Second ipsilateral PTX
  • First Contraleral PTX
  • First PTX in high risk job (diver, pilot etc)
  • Bilateral Spontaneous PTX
16
Q

What surgical techniques are there for PTX?

A
  • Surgical or Talc Poudrage pleurodhesis

- Pleurectomy