case report 2016(修改)概要1.ppt

Chest X-ray 2016-01-09 22:14 Right hydropneu-mothorax (30%) PNEUMOTHORAX Definition Classification Diagnosis Treatment Recurrence Rate Identify problem ? Brainstorming ? Solution * Pneumothorax Presence of gas in the pleural space resulting in pulmonary collapse. * Classification * Pneumothorax Spontaneous Traumatic Primary Secondary Iatrogenic Penetrating Blunt Tall / Slender M : F = 6 : 1 Rupture of apical blebs / bullae Risk: cigarette smoking Underlying pulmonary disease (COPD, ILD, infections, neoplasms) * Diagnosis Diagnosis： Symptoms sign CXR: pleural line PNX%＝100[1-lung3/hemithorax3] *Sadikot et al. Recurrence of primary spontaneous pneumothorax, Thorax 1997;52(9):805-809 P-THORAX Pleuritic pain Tracheal deviation Hyperresonance Onset sudden Reduced breathing sounds (and dyspnea) Absent fremitus X-ray shows lung collapse * * Treatment ~ PSP O2 supplement 10 L/min (2% reabsorption rate in RA), 6hrs observation at ER simple aspiration 70% successful rate, BUT failure when age50, 2.5 L air aspiration small-bore(7-14 Fr) cath, or chest tube with one-way valve Heimlich valve or water-seal device Small Pneumothorax Large Pneumothorax * * Recurrence Rate Recurrence Rates*： Ipsilateral: 39%, 1year Contralateral: 15% Risk: smoking After first recurrent, rate of 3times recurrence: 50% *Sadikot et al. Recurrence of primary spontaneous pneumothorax, Thorax 1997;52(9):805-809 s/p Chest Thoracostomy Chest X-ray 2016-01-10 00:20 Problem: Right spontaneous hydropneumothorax s/p tube thoracostomy; RUL bullae Poor function ? OBS At 7:30, 300ml bloody drained ? Pale, cold sweating ? T 36.4℃,P 106/min,R 18/min,BP 73/37mmHg, PE faint BS over right ? clamp IVF challenge, BP 73/37mmHg ? declamp-reclamp to prevent tension pneumothorax Hospital Course ~ 2016-01-10 * Hospital Course ~ 2016-01-10 * Shock, suspect SHP SPONTANEOUS HEMOPNEUMOTHORAX DEFINITION LIFE-THREATENING ITS MECHANISM TREATMENT PROGNOSIS Identify problem ? Brainstorming ? Solution * Definition *