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Flashcards in Respiratory Emergencies Deck (66)
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1

What is a pneumothroax

- Air in the pleural space

2

What are the causes of spontaneous pneumothorax

- Primary - normal lung
- Secondary - underlying lung disease

3

Who does a spontaneous peneumothorax commonly occur in

- tall, thin men
- male: female 5:1
- cigarettes 22x more common
- cannabis
- rarely familial
- biomodal - more commonly in 15-34 and then over 55s

4

What is the pathophysiology of a pneumothorax

Air leak from Apical bulla in visceral pleura leading to a right spontaneous pneumothorax

5

What is the cause of secondary pneumothorax

- COPD (60%)
- Asthma
- Connective tissue disease – Marfan’s
- Interstitial lung disease : fibrosis
- Lung infection = Tuberculosis
- Cystic Fibrosis

6

What are the clinical symptoms of pneumothorax

- Sudden onset/acute
- Pleuritic chest pain
- +/-SOB

7

What are the differential diagnosis for pneumothorax

Respiratory
- pulmonary embolus
- pneumonia
- acute exacerbation of respiratory disease

Cardiovascular
- acute coronary syndrome/MI
- pericarditis
- aortic dissection/aneurysm rupture
- cardiac tamponade

Other
- musculoskeletal pain
- GORD
- Panic attack

8

What are the clinical signs of pneumothorax

- reduced expansion
- hyper-resonant percussion
- quiet breath sounds
- tachycardia

9

What is a cause of subcutaneous emphysema

- spontaneous pneumothorax
-

10

How do you investigate a pneumothorax

- CXR
- ECG
- bloods
- CT chest

11

what do you see in a chest X ray of someone with a pneumothorax

CXR
- Lung edge
- No peripheral lung markings

- Small <2cm
- Large ≥ 2cm (50%)

12

What is the difference between a small and large pneumothorax

- Small <2cm
- Large ≥ 2cm (50%)

13

How do you manage pneumothorax

Conservative
- observation
- high flow oxygen

Medical
- pleural aspiration
- chest drain
- suction
- medical pleurodesis - can use Tetracycline/doxycycline / Talc
to stick the pleural together

Surgical - stick visceral and parietal pleura together
- open thoractomy
- video assisted thoracic surgery (VATS)

14

what makes up the safe triangle

- lateral edge of pec major
- base of axilla
- 5th intercostal space (go in above a rib)
- lateral edge of lat doors

15

describe the management of a primary pneumothorax

- Primary pneumothorax and less than 2cm discharge and review in OPD in 2-4 weeks
- if primary pneumothorax and greater than 2cm then aspirate with 16-18G cannula, aspirate <2.5L
- if success (rib less than 2cm and breathing improved) then consider discharge
- if not a success chest drain and admit

16

Describe the management of a secondary pneumothorax

- secondary pneumothorax and less than 2cm, check if the size is 1-2cm
- if no - admit to high flow oxygen and observed for 24 hours
- if yes aspirate with a 16-18G cannula, and aspirate at less than 2.5L
- if this is a success admit, high flow oxygen and observe for 24 hours
- if this isn't a success, chest drain and admit

Secondary pneumothorax and greater than 2cm and/or breathless
- chest drain and admit

17

describe how you manage a chest drain

- Underwater seal drainage
- Don’t lift bottle above waist
Retrograde entry of fluid/air into pleural space
- Never clamp a bubbling chest drain = TENSION PNEUMOTHORAX

18

What are the symptoms of a tension pneumothorax

- Severe breathlessness
- Tachycardia
- Pulsus paradoxus
- Distended jugular veins
- Tracheal deviation
- Ipsilateral reduced/absent
breath sounds

19

describe the pathophysiology of a tension pneumothorax

On inspiration air goes out of the lung into the pleural space (-ve intrathoracic pressure)
- then on expiration air cannot get back into the lung resulting in positive intrathoracic pressure

20

What are the symptoms of a tension pneumothorax

- One-way valve
- Shift in mediastinum
- Reduced venous return
- Hypotension
- Cardiac arrest

21

How do you treat a tension pneumothorax

- Don’t wait for CXR
- Needle decompression
- Large bore cannula (14 G)
- Mid clavicular line, 2nd intercostal space
- Hiss of air as you release the tension

22

where do you put the needle in a tension pneumothorax

- Large bore cannula (14 G)
- Mid clavicular line, 2nd intercostal space

23

What advice should you give someone who has a pneumothorax

- no diving
- stop smoking
- no aeroplane travel for at least 2-6 weeks
- pregnancy can increase risk of recurrence - monitor closely
- return immediately if any shortness of breath or chest pain recurs

24

What is the risk of recurrence in a primary pneumothorax

Primary pneumothorax
- 33% to 40% risk of recurrence after first pneumothorax

25

What is the risk of a recurrence in a secondary pneumothorax

Recurrence 39-47%

26

what is the mortality for pneumothorax

- 0.62/million per year for women
- 1.26/million per year for men

27

What is the definition of a pulmonary embolism

Obstruction of pulmonary arterial system due to Thrombi from distant vein

28

what are the two types of PE

- provoked
- unprovoked

29

What is a provoked PE

- due to a transient risk factor
- within the last 3 months
- removing this will reduce risk of recurrence

30

what is an unprovoked PE

- no transient risk factor
- persistent risk factor which is not correctable
- increased risk of recurrence