Pneumothorax physical examination and management

Pneumothorax physical examination and managementCreated OnMay 29, 2020Last Updated OnMay 29, 2020byadmin You are here: Main Clinical Examination Pneumothorax physical examination and management < All Topics Table of Contents Physical examination: General examination Observation Assess the level of consciousness – Indicate the severity Note whether patient can speak in words/phrases/sentences/couldn’t speak Dyspnea, count respiratory rate Observe for any signs of distress Pleuritic chest pain Respiratory distress – Tachypnea (grunting, nasal flaring and retractions in infants) Tachycardia (initially but may become bradycardic as air leak worsens) Diaphoresis Cyanosis Hypertensive (initially but may become hypotensive as air leak worsens) Current oxygen therapy – Nasal prongs/ Simple face mask/ High flow mask/ Venturi mask, connected to oxygen (how many litre/min) Bedside – Inhalers, medications(Can be a COPD patient) Face Cyanosis Neck JVP distention (tension pneumothorax) Right Pneumothorax Inspection Reduced movement on right side with chest fullness on intercostal space Subcutaneous emphysema Look for any injuries Palpation Trachea shifted to left Apex beat shifted Chest expansion reduced Vocal fremitus reduced Percussion Hyperresonant Auscultation Reduces/absent breath sound Vocal resonance reduced No added sound Investigation: Chest radiograph– confirm diagnosis Expiratory films are no more sensitive than standard films Lateral decubitus views facilitate the detection of tiny pneumothorax 2. ABG 3. Thoracic ultrasound False-positive findings with bullous lung disease (e.g., COPD) or previous pleurodesis 4. CT scan- gold standard Not used in routine practice Patients who are mechanically ventilated: high peak airway pressures (PIP)* due to difficulty ventilating *PIP is measured at the airway opening and is routinely displayed by mechanical ventilators Treatment: Needle decompression (a 14-16G intravenous cannula2nd 3rd intercostal space (ICS), mid-clavicular line (MCL)) Indications Unstable patient Chest radiograph not immediately available SpO2, <92% on O2 Systolic BP, <90 mm Hg Respiratory rate, <10 Decreased level of consciousness on O2   Tube thoracostomy (4th or 5th ICS in midaxillary line-at the safety triangle) Preferably with the patient sitting at 45 degree Do chest x-ray before and after Give 100% oxygen stat Common short case questions for pneumothorax What are the causes of pneumothorax ? Spontaneous, chronic lung diseases, TB, pneumonia, traumatic, carcinoma, marfan’s syndrome, ehlers-danlos syndrome   What are the cardiovascular manifestation of pneumothorax? Cardiac apical displacement, Jugular venous distention, Hypotension, Pulsus paradoxus, Tachycardia   What are the...

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