Thoracic Emergency

Content

Acute Upper Airway Obstruction

Massive Haemoptysis

Spontaneous Pneumothorax

Pulmonary Empyema

Acute upper airway

obstruction

Death due to upper airway obstruction peak at 85y

Acute causes
1. Foreign body
2. Trauma
3. Inflammation
4. Tumor

Chronic
A. Stenosis ( critical if < 4mm)

Clinical presentation

Cough

Hoarseness of voice

Shortness of breath

Stridor

Dyspnea

Using accessory muscles

Cyanosis

Management

Aspiration

Heimlich maneuver

Unsuccessful and stable --> OT & rigid

bronchoscopy

Unsuccessful and unstable -->

cricothyrotomy

Management

Non-aspiration

Airway patent and time permit --> CT scan

Airway unstable --> rigid or flexible bronchoscopy

Rigid preferable because

1. Coring the tumor
2. Dilating a stricture
3. Aspiration of secretion

Massive Haemoptysis

Def : coughing out > 600 ml/24h

Causes
1. Bronchiectasis
2. Tuberculosis
3. Mycetomas
4. Necrotizing pneumonia
5. Bronchogenic carcinoma

Management

ABC

Identify which lung and which lobe

Optional --> CT scan

Interventional radiology for angiography and

embolisation (1st line )
1. Mild bleeding > 1/52 after intervention
2. Blood transfusion
3. Aspergillomas

Management

Flexible/rigid bronchoscopy
A. Cold lavage
B. Adrenaline

Tranexamic acids

Management

Surgery
A. Arteriovenous fistula
B. Iatrogenic pulmonary artery rupture
C. Chest trauma
D. Recurrent life threatening haemoptysis

Spontaneous
pneumothorax

Primary

Not know lung pathology

Male, tall and thin

Secondary

COPD

Tuberculosis

Cystic fibrosis

Lung cancer

Clinical presentation

Tachypnea

Tachycardia

Hypotension

Dilated internal jugular vein

Asymmetry chest expansion

Reduced breath sound

Management

Symptomatic

Chest tube

Asymptomatic and small pneumothorax

Treat conservatively

Management

Primary

First episodes with high risk job

Pilot and sea divers

If not intervention after second episode

Surgical intervention (open vs VATS ) -->

excision of diseased lung/lobe + pleurodesis

Pulmonary empyema

Causes
1. Pneumonia
2. Parapneumonia effusion

3 stages
A. Early exudating
B. Intermediate fibrinopurulent
C. Late organizing

Clinical presentation

Usually subtle

Anorexia, loss of weight

Fever, cough, dyspnea usually associated

with underlying disease

Diagnosis

Chest x-Ray --> loculated

CT Thorax

Fluid for analysis

Management

Early

Chest tube (size of tube does not matter)

Antibiotic only if pt has underlying

pneumonia

Intermediate --> decortication

Late --> filling the space (flap or

thoracoplasty)

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