pneumothorax class
TRANSCRIPT
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Dr. Boney Cheriyan ThavalathilEmergency Physician & Intensivist,
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Normal pleural space = closed sac in which negative pressure is essential for normal lung expansion during breathing
What’s the normal pleural pressure?
Beginning of inspiration - 5 cm H2O
End of inspiration - 7.5 cm H2O
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“Pneumo” – Gas “Thorax” – Chest cavity Occurs when air leaks into the space between the
lungs and chest wall, creating pressure against the lung
SourcesVisceral pleuraRuptured esophagusChest wall defectGas-forming organisms
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TraumaticBluntPenetrating
IatrogenicDiagnosticTherapeutic
Spontaneous PrimarySecondary
COPDInfectionNeoplasm
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Penetrating Trauma Air entering pleural space directly through chest wall
Blunt Trauma
High Risk Occupations
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Transthoracic Needle Aspiration biopsy
Transbronchial Biopsy
Thoracocentesis
Central Venous Catheter Placement
Intercostal Nerve Block
Tracheostomy
Positive Pressure Ventillation
NG tube placement
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Penetrating & Non- Penetrating traumaThoracic Spine Fracture Dislocations
Cohesive forces between visceral & parietal pleura disruptedCollapse of the lung
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Signs Tachypnea
Tachycardia
Hypotension
Hypoxia
Symptoms
Breathlessness Pleuritic Chest pain
Sudden onset
Tension pneumothorax
Spontaneous pneumothorax
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Respiratory
Decreased Breath Sounds
Hyperresonance to percussion
Decreased Tactile Fremitus
Altered Mental Status
Cardiovascular
JVDShift in mediastinum
OtherSubcutaneous
EmphysemaShifted Trachea
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Tension pneumothoraxFailure to reexpandPersistent air leakRecurrence
Removal of intrapleural airInfection Reexpansion pulmonary edema
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Mediastinal shift
Kinking of SVC & IVC
Decrease in Venous Return to heart
Decrease In C.O
SHOCK & HYPOPERFUSION
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ABG
PO2 : decreased
PCO2:Decreased from Hyperventilation
Elevated with respiratory compromise
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CXR Inspiratory & expiratory
imagesUnderlying Pul. disease
Harder to detect
CTPSP – Blebs & Bullae Small pneumothoraxAssess the need for
thoracotomy
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Absence of “lung sliding” as assessed on the time-motion view
Demonstration of a "lung point" on the time-motion view
Absence of vertical comet-tail artifacts
USGUSG 95% sensitivity95% sensitivity 100% specificity100% specificity
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“Seashore sign” “Stratosphere sign”
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Normal Abnormal
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Normal Abnormal
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ABC
History
Examination
Needle aspiration and small chest tube drainage
Goals
Elimination of intrapleural air
Optimization of pleural healing
Prevention of recurrences
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Immediate decompression via chest tube or needle thoracostomy
If a tension pneumothorax is present, a “hiss of air” may be heard escaping from the chest cavity
Remove the needle, leave the catheter in place
Rx
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Immediate managementWound dressing
Flutter-Type Valve Effect
Rx
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Clear and manage the airway
Provide oxygen
Seal an open wound with an occlusive dressing
Rx
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Tape down three sides and create a flutter valve
Rx
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Chest tubeRemote from the wound
Definite managementSurgical closure of the wound
Rx
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OxygenPneumothorax is smaller than 15% Patient is asymptomatic
Needle aspirationPneumothorax is smaller than 15%Symptomatic & hemodynamically stable
Pigtail catheterPneumothorax is greater than 15%
Rx
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Tube Thoracostomy
Recurrent PneumothoraxCT to evaluate need for thoracotomy
Thoracoscopy with stapling of blebs
Pleural abrasion & Sclerosing agent (Doxycycline or Talc)
Rx
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Aspiration
Tube thoracostomy
Rx
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