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19 Cards in this Set
- Front
- Back
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Definition |
Pneumothorax occurs when air gains access to, and accumulates in, the pleural space |
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Epidemiology |
Common - 2.5 more common in men. 22x more likely in a male smoker and 8 times in a female smoker |
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Aeitology |
Primary - without preceding trauma or precipitating event. HX smoking, Marfan's syndrome, homocystinuria, or FMx of pneumothorax - tall young smokers Secondary - complication of underlying disease - COPD, CF and TB Tension - 1 way valve, build-up of air within the pleural space ( blunt injury to the chest) |
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Pathophysiology |
Normally - alveolar pressure > intrapleural pressure. intrapleural pressure < atmospheric
Space either way >>> accumulation in pleural space. Thoracic cavity enlarges > lung gets smaller
Primary is often bullae/blebs (air pockets) |
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Signs, symptoms and risk factors |
Symptoms: chest pain, dyspnoea Signs: absent breath sounds and hyper-resonant. Deviated trachea Risk factors: Smoking, FMx, tall and thin, CODP, TB, trauma, surgery, CF and asthma |
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Investigations |
CXR: visceral pleural line typically identified
CT scan and bronchoscopy |
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DDx |
Acute exacerbation, PE, MI and pleural effusion |
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Criteria |
Small visible rim of <2 cm between the lung margin and the chest wall at the level of the hilum
Large pneumothorax - a visible rim at least 2 cm between the lung margin and the chest wall at the level of the hilum |
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Treatment - tension pneumothorax |
Decompression - immediate insertion of a standard 14-gauge intravenous catheter into the pleural space at the intersection of the midclavicular line and the second or third intercostal space. Intervention should not be delayed by awaiting radiographic confirmation of the tension pneumothorax |
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Treatment - spontaneous pneumothorax |
Primary Small - Observation and oxygen Large - Aspiration > chest-tube thoracostomy Secondary Chest-tube thoracostomy |
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Prognosis and guidelines |
High risk of recurrence
Air travel should be avoided until full resolution
Diving should be permanently avoided unless the patient has undergone bilateral surgical pleurectomy and has normal lung function and chest CT scan postoperatively |
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DALTEPARIN |
Anticoagulant. Increases ATIII, reducing Xa |
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LANZOPRAZOLE + OMEPRAZOLE |
PPI - inhibition H+K+ATPase. Final step of acid production |
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ALENDRONIC ACID |
Bisphosphonate - inhibits osteoclasts. Works by inhibiting FPP synthase which is an enzyme on mevalonate pathway |
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PARACETAMOL |
COX inhibitor. Increases pain threshold by reducing prostaglandins |
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CODEINE PHOSPHATE |
10% becomes morphine which acts on mu opioid receptors. Binds to GABA inhibitory neurons. Less inhibition of pain inhibition pathway |
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ORAMORPH |
acts on mu opioid receptors. Binds to GABA inhibitory neurons. Less inhibition of pain inhibition pathway |
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ONDANESTRON |
Antiemetic - selective serotonin 5-HT3 receptor antagonist. Inhibits visceral stimulation of vomiting centre |
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PREDNISOLONE |
Steroid. ligand complex translocates into cell nucleus and interacts with transcription factors
Inhibits leukocyte infiltration
Inhibit release of alendronic acid |
