The_Chest_ptx_ - The Chest: Pneumothorax, Hemothorax,...

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The Chest: Pneumothorax, Hemothorax, Bradley J. Phillips, M.D. Burn-Trauma-ICU Adults & Pediatrics
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Pneumothorax definition, classification, & management
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Pneumothorax (1) collection of air within the pleural space transforms the potential space into a real one may lead to various degrees of respiratory compromise with progression, the intrapleural pressure may exceed atmospheric pressure creating a tension-scenario impairs respiratory function decreases venous return to the right-side of the heart
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Pneumothorax (2) General Management First: evacuate the air Second: address the underlying source Third: promote pleural symphysis
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Pneumothorax (3) Classification System Spontaneous Pneumothorax Primary Secondary Traumatic Pneumothorax Pulmonary source Tracheobronchial source Esophageal source
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Pneumothorax (4) Primary Spontaneous Ptx a disease of younger individuals (15 - 35 yrs of age) males > females tall, slim body habitus cigarette smoking implicated usual cause: parenchymal blebs apex of the upper lobe superior segment of the lower lobe
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Pneumothorax (5) Primary Spontaneous Ptx: “in most instances, the treatment of a first-occurrence consists of hospitalization, tube-thoracostomy to closed drainage, lung-re-expansion against the chest wall, and control of any persistent air-leak” [Graeber ‘98]
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Pneumothorax (6) when do you operate on a primary spontaneous pneumothorax ?
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Pneumothorax (7) Secondary Ptx: due to underlying pulmonary disease COPD / Asthma / Cystic Fibrosis Immunocompromised Infections Tb Cocci PCP (becoming more common) Treatment: Closed Thoracostomy Water-seal Heimlich-Flutter Valve V.A.T.S.
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Pneumothorax (8) Traumatic Ptx Parenchymal Injury vs. Tracheobronchial vs. Esophageal Blunt or Penetrating Iatrogenic central lines / thoracentesis / biopsy endotracheal tube placement (esp. dual-lumen tubes !) endoscopy / dilational techniques Barotrauma Ventilation / blast injury / Boerhave’s syndrome Operative
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Pneumothorax (9) The Tension Ptx “path of least resistance” life-threatening emergency… how do you treat a tension ptx ?? The Open Ptx: sucking-chest wound intrinsic lung compliance creates complete collapse 3-sided dressing thoracostomy away from the traumatic wound
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Pneumothorax (10) Treatment Options Observation: Inpatient vs. Outpatient Thoracostomy Drainage
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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The_Chest_ptx_ - The Chest: Pneumothorax, Hemothorax,...

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