Pneumothorax

hi this is tom from zero2finals.com in this video i'm going to be going through pneumothorax and you can find written notes on this topic at slash zero2finals.com or in the respiratory section of the zero to finals medicine book let's jump straight in a pneumothorax occurs when air gets into the pleural space that separates the lungs from the chest wall it can occur spontaneously or it can occur secondary to other things like trauma medical interventions or lung pathology the typical patient with the pneumothorax in your exams is a young tall thin young man presenting with sudden shortness of breath and pleuritic chest pain possibly whilst playing sports so if you see a patient like this appear in your exam think about a pneumothorax let's talk about the causes like we said it can be spontaneous so pneumothorax can occur for apparently no reason it can be secondary to trauma so think about it if somebody's been in a bicycle accident or a traffic accident or something like that it can be iatrogenic which means it's due to something that we've done some medical interventions and this could be a lung biopsy it could be mechanical ventilation or insertion of a central line and it can occur due to lung pathology like infection asthma or copd the way to diagnose a pneumothorax is to use a chest x-ray and an erect chest x-ray particularly is the investigation of choice for diagnosing a simple pneumothorax and by erect we mean that we want the patient to be standing upright with their lungs fully expanded so we get a really clear picture of the lung fields an erect chest x-ray will show an area between the lung tissue and the chest wall where there's no lung markings there will be a line that demarcates the edge of the lung where the lung markings end and the pneumothorax begins you can measure the size of a pneumothorax on a chest x-ray and it can be done according to the bts or the british thoracic society guidelines from 2010 and this involves measuring horizontally from the edge of the lung to the inside of the chest wall at the level of the hilum and this will give you the size of the pneumothorax a ct thorax or a ct of the chest can detect even small pneumothoraxes that are too small to see on a chest x-ray and it can be used to accurately assess the exact size of the pneumothorax how do you manage pneumothorax well we can base the management on the 2010 guidelines from the british thoracic society so just to summarize those guidelines if there's no shortness of breath and it's less than two centimeters in size on the chest x-ray then no treatment is required as it usually spontaneously resolves and you need to follow up in two to four weeks with a chest x-ray to see whether the pneumothorax has resolved if there is shortness of breath or it's more than two centimeters in size on the chest x-ray then it will need aspiration and reassessment after that if the aspiration fails twice then you'll need to do a chest drain to properly resolve the pneumothorax any patient that is unstable or there's bilateral pneumothoraxes or they're secondary to some other pathology will usually require a chest drain we need to talk about something called a tension pneumothorax an attention pneumothorax is caused by trauma to the chest wall that creates a one-way valve that lets air into the pneumothorax but doesn't let it out of the pleural space so the one-way valve means that during inspiration air is drawn into the plural space and then during exploration the air is trapped in the plural space therefore more air keeps filling in to this plural space with each breath and it can't escape this means the pneumothorax gets progressively larger with each breath this is obviously very dangerous as it creates increased pressure inside the thorax and it will end up pushing the mediastinum across kinking the big vessels in the mediastinum and causing cardiorespiratory arrest what are the signs so that you can recognize attention pneumothorax importantly there'll be tracheal deviation and this will be away from the side of the pneumothorax there'll be reduced air entry on the affected side when you percuss the chest there'll be increased resonance on the affected side because it's full of air and there'll be hemodynamic instability due to the pressure on the heart so there'll be tachycardia with a fast heart rate and hypotension with a low blood pressure how do you manage attention pneumothorax well the management of attention pneumothorax is something that's worth just memorizing for your exams and something that you can recite when asked how to manage it and the answer is to insert a large bore cannula into the second intercostal space in the midclavicular line and what this does is it creates a way for the air to get out of the pneumothorax or out of the pleural cavity and relieves the tension so that the lungs can re-expand and the mediastinum and the cardiac vessels can return to their normal place if you suspect there's attention pneumothorax then you shouldn't wait for any investigations because this can delay it and each breath is increasing the size of that pneumothorax and increasing the risk of cardiorespiratory arrest once the pressure is relieved with a cannula then the patient should stabilize and the chest drain can be put in which will give definitive management to remove that air so that brings us on to talking briefly about a chest drain chest drains are tubes that are put inside the pleural space to relieve fluid or air from the pleural cavity chest drains are inserted into something called the triangle of safety and it's called the triangle of safety because when you put the chest strain into this area you're least likely to damage local structures this triangle is formed by the fifth intercostal space or the inferior nipple line the mid auxiliary line or the lateral edge of the latissimus dorsi and the anterior axillary line or the lateral edge of the pectoris major and these three landmarks form a triangle that can be the location of the chest drain the needle is inserted just above the rib and this is to avoid the neurovascular bundle that runs just underneath each rib once the chest drain is inserted you need to obtain a chest x-ray to check the positioning so thanks for watching i hope you found this video helpful if you did don't forget there's plenty of other resources on the zero to finals website including loads and loads of notes on various different topics that you might cover in medical school with specially made illustrations there's also a whole test section where you can find loads of questions to test your knowledge and see where you're up to in preparation for your exams there's also a blog where i share a lot of my ideas about a career in medicine and tips on how to have success as a doctor and if you want to help me out on youtube you can always leave me a thumbs up give me a comment or even subscribe to the channel so that you can find out when the next videos are coming out so i'll see you again soon

Channel: Zero To Finals

Views: 239,190

Keywords: medical, education, medicine, doctor, pneumothorax, respiratory

Id: M4D0I45_mQ0

Length: 8min 19sec (499 seconds)

Published: Thu Oct 01 2020