4.2 I) Respiratory Pneumothorax

Front 1

Common causes of Secondary Spontaneous pneumothorax ? {8}

Back 1

1. COPD ***
2. Asthma
3. Pneumonia [ PjP]
4. TB
5. Interstitial lung disease
6. Cystic fibrosis
7. Malignancy
8. Endometriosis

Front 2

Recurrence rates of primary spontaneous Pneumothorax ?

Back 2

33% {range 16-50%} [Rosens]

Front 3

Risk factors for recurrence of Primary spontaneous pneumothorax? {3}

Back 3

1. Younger age
2. Lower weight: height ratio
[ ie. tall and thin]
3. smoking

Front 4

Recurrence rates after secondary spontaneous pneumothorax?

Back 4

40-50% [Rosens]

Front 5

List the treatment options for pneumothorax? [Dunn]

Back 5

1. Observation -Conservative
2. Oxygen
3. Simple needle aspiration
4. Small bore catheter
5. Chest tube
6. Operative [ chemical pleurodesis / VATS / open thoracotomy -pleurodectomy ]

Front 6

Factors affecting decision for Mx of pneumothorax? [Dunn]

Back 6

1. Presence of tension PTX
2. Size [ 2cm : BTS ; 3 cm : ACCP]
3. Severity of symptoms
4. Degree of air leak
5. presence of haemothorax
6. Primary versus secondary versus traumatic

Front 7

Criteria for immediate decompression of tension pneumothorax? [5 ] [Dunn]

Back 7

1. Pre-arrest / cardiac arrest
2. decreased level of consciousness on oxygen
3. SaO2 < 92% on oxygen
4. SBP < 90 mmHg
5. Respiratory rate < 10

Front 8

Indications for needle aspiration / small bore catheter for pneumothorax?

Back 8

1. Symptomatic primary PTX [ > 2 cm ; SOB ]
2. Secondary PTX 1-2 cm {BTS}
3. iatrogenic needle induced PTX
4. Traumatic: Isolated injury ; stable patient

Front 9

Contraindications for needle aspiration / small bore catheter for PTX?

Back 9

1. Large primary PTX
2. Large secondary PTX [ > 2cm]
3. Age > 50
4. Haemothorax

Front 10

Indications for Chest tube in Pneumothorax?

Back 10

1. Primary spontaneous
i) Unstable
ii) Failed aspiration [ needle / small bore catheter]
iii) Large
2. Secondary
i) large > age 50 [ BTS]
ii) All [ACCP]
3. Tension PTX - post needle decompression
4. Ventilated patients
5. Bilateral PTX
6. Post traumatic
[ EXCEPT :
i) needle induced iatrogenic
ii) Small, LATE presentation
iii) small-CT detected

Front 11

List the methods of measuring the size of a pneumothorax.

Back 11

1. Average Interpleural Distance technique.
2. British Thoracic Guidelines
3. American College of Chest Physicians.

Front 12

How does the Average Interpleural distance technique estimate the size of a pneumothorax ?

Back 12

The sum of the distances between the pleural surfaces at 3 regions :
1. Apex
2. Middle of upper half of lung
3. Middleof lower half of lung.

divide by 3
1 = 14%
2 = 22 %
3 = 31 %
4 = 40 %

Front 13

How does the British Thoracic Guidelines estimate the size of a pneumothorax?

Back 13

Visible rim < or > 2 cm

> 2cm = "large" > 50%