Tension pneumothorax - Interesting Emergency Case presentation
•Download as PPTX, PDF•
15 likes•5,113 views
Tension pneumothorax - Emergency Case presentation
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Tension pneumothorax - Interesting Emergency Case presentation
Similar to Tension pneumothorax - Interesting Emergency Case presentation (20)
More from Dr. Nagu Penakacherla
More from Dr. Nagu Penakacherla (12)
Recently uploaded
Recently uploaded (20)
Tension pneumothorax - Interesting Emergency Case presentation
- 1. Emergency Department Case Presentation - 3 By Dr. Nagu Penakacherla MBBS, MEd(USA), DNB (Family medicine ) 14/06/2017 1
- 2. Chief Complaints • Patient presented with complaints of sudden onset of shortness of breath @ 11.30 am associated with cough and sputum expectoration from morning. • Also complains of chest pain since morning . • No H/o Trauma / Prolonged travel/surgery/ immobilization recently. 14/06/2017 2
- 3. • No H/o Fever /DM Type 2 /HTN/COPD/IHD / Asthma • Past History of Tuberculosis + • Family history – Not significant • Personal History- Not an alcoholic but patient was smoker but left it 10 years back. • Sexual history- No STD’s 14/06/2017 3
- 4. On Examination • HEENT – Nothing significant • No pallor/cyanosis/icterus/clubbing /pedal edema • Patient is emanciated and weak. • Temperature- 98.6 F • Pulse 78/min • B.P 150/90 mm Hg • Respiratory rate 22/min 14/06/2017 4
- 5. • CVS : S1 S2- Normal, No murmur • RS: Bilateral Breath sounds decreased, Left > Right , Bilateral Wheeze + • PA: Soft, No Tenderness, Normal Bowel sounds • CNS: WNL 14/06/2017 5
- 6. • Whats Your differential Diganosis ?? • What tests you perform Next?? 14/06/2017 6
- 7. • ECG- Ischemic changes ABG- Type 1 Respiratory failure Chest – X ray - 14/06/2017 7
- 8. 14/06/2017 8
- 10. 14/06/2017 10
- 11. 14/06/2017 11
- 12. 14/06/2017 12
- 13. • After 48 hours patient was discharged with • MDI TIOVA & MDI ASTHALIN • Tests in ICU • Trop T- 3 and CPK-MB 5.56 • ECHO- Mild PAH otherwise Normal 14/06/2017 13
- 14. Secondary Spontaneous Pneumothorax Reference: Management of spontaneous pneumothorax, British Thoracic Society pleural disease guideline 2010 14/06/2017 14
- 15. 14/06/2017 15
- 16. 14/06/2017 16
- 17. 14/06/2017 17
- 18. 14/06/2017 18
- 19. 14/06/2017 19
- 21. • Definition: • A chest tube (chest drain, thoracic catheter, tube thoracostomy, or intercostal drain) is a flexible plastic tube that is inserted through the chest wall and into the pleural space or mediastinum. • It is used to remove air (pneumothorax) or fluid (pleural effusion, blood, chyle), or pus (empyema) from the intrathoracic space. It is also known as a Bülau drain or an intercostal catheter. • Indications: • Pneumothorax - SSP - Unstable pneumothorax - Severe dyspnoea - Lung collapse - Frequent recurrent pneumothorax - Simple or catheter aspiration drainage is unsuccessful in controlling symptoms. • Pleural effusion • Chylothorax • Empyema • Hemothorax • Hydrothorax • Postoperative: for example, thoracotomy, oesophagectomy, cardiac surgery
- 22. • Contraindications • Refractory coagulopathy • Presence of a diaphragmatic hernia • Hepatic hydrothorax. • Additional contraindications include scarring in the pleural space (adhesions). • Position of intercostal tube: • The chest tube should be positioned in the uppermost part of pleural space, where residual air accumulates. • This procedure permits the air to be evacuated from the pleural space rapidly. • The site of chest tube insertion is in anterior axillary line of fifth or sixth intercostal space.
- 24. Suction • Not routinely used because may cause re expansion pulmonary edema • Indicated when persistent air leak with or without incomplete re-expansion of the lung after 48 hrs • High-volume low-pressure systems such as Vernon-Thompson pumps or wall suction with low pressure adaptors 14/06/2017 24
- 25. Thoracic surgeon Indications for surgical advice: • Persistent air leak (despite 5 to 7 days of chest tube drainage) or failure of lung re-expansion. • Synchronous bilateral spontaneous pneumothorax. • Professions at risk (eg, pilots, divers). • Pregnancy. • Second ipsilateral pneumothorax. • First contralateral pneumothorax. • Spontaneous haemothorax 14/06/2017 25
- 26. Advice & f/up • Avoid air travel until 1 weeks post fully resolution • Avoid diving unless has undergone bilateral surgical pleurectomy and has normal lung function and chest CT scan postoperatively • Observation/ NA F/up in 2-4 weeks 14/06/2017 26
- 28. 14/06/2017 28
Editor's Notes
- PSP & SSP SSP associated with lung disease e.g. TB, COPD & symptoms more severe than PSP Size of pneumothorax not determine the severity of symptoms Tension pneumothorax cardiorespiratoy distress i.e. cyanosis, sweating, severe tachypnoea, tachycardia and hypotension Pneumothorax – erect inspiratory PA cxr displacement of pleural line CT scan for small pneumothorax
- PSP Male, young, tall & thin
- PSP referral to chest physician in 24hr, ref to thoracic surgeon if persistent air leak in 5-7 days chest tube SSP early referral, d/w thoracic surgeon if persistent air leak in 48 hrs Surgical empysema?
- The size of the pneumothorax determines the rate of resolution and is a relative indication for active intervention. Best measured by Digital radiography (Picture-Archiving Communication Systems, PACS)
- Chemical plerodesis – sclerosing agent e.g. tetracycline open or VATS approach
- AIM: resect any visible bullae or blebs on the visceral pleura and also to obliterate emphysema-like changes9 or pleural porosities under the surface of the visceral pleura.8 The second objective is to create a symphysis between the two opposing pleural surfaces as an additional means of preventing recurrence 1. Open thoracotomy and pleurectomy remain the procedure with the lowest recurrence rate (approximately 1%) for difficult or recurrent pneumothoraces. (A) 2. Video-assisted thoracoscopic surgery (VATS) with pleurectomy and pleural abrasion is better tolerated but has a higher recurrence rate of approximately 5%. (A) 3. Surgical chemical pleurodesis is best achieved by using 5 g sterile graded talc, with which the complications of adult respiratory distress syndrome and empyema are rare.