Pneumothorax & Tension Pneumothorax

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USMLE Step 2 Pulmonology (2c Diseases of the Pleura) Karteikarten am Pneumothorax & Tension Pneumothorax, erstellt von Aaron Samide am 14/05/2016.
Aaron Samide
Karteikarten von Aaron Samide, aktualisiert more than 1 year ago
Aaron Samide
Erstellt von Aaron Samide vor fast 8 Jahre
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2-year recurrence rate of spontaneous pneumothorax 50%
Symptoms associated with pneumothorax (3) - Sudden, ipsilateral chest pain - Dyspnea - Cough
Physical signs of pneumothorax (4) - Decreased breath sounds on affected side - Hyperresonance - Decreased/absent tactile fremitus - Mediastinal shift towards affected side
Treatment of primary spontaneous pneumothorax if small & asymptomatic Observation
Treatment of primary spontaneous PTX if larger and/or symptomatic Supplemental oxygen Needle aspiration or chest tube insertion
Treatment of secondary spontaneous pneumothorax (complication of underlying lung disease) Chest tube drainage (more life-threatening because of decreased pulmonary reserve in these patients at baseline)
General pathophysiology of tension pneumothorax Accumulation of air within pleural space --> tissues surrounding the opening into pleural cavity act as valves, allowing air to enter but not escape Resultant positive pressure in pleural space collapses the ipsilateral lung & shifts mediastinum away from that side
3 causes of tension pneumothorax - Mechanical ventilation (barotrauma) - CPR - Trauma
Clinical features of tension pneumothorax (5) - Hypotension (impaired cardiac filling) - Distended neck veins - Tracheal shift to other side - Decreased breath sounds on affected side - Hyperresonance to percussion on affected side
T/F: A CXR should be obtained first if tension pneumothorax is suspected False; immediately decompress the pleural space w/ large-bore needle or chest tube!
Where should the large-bore needle be placed to decompress the chest in the case of a tension PTX? 2nd or 3rd intercostal space in mid-clavicular line
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