Pneumothorax

Question 1

What is a pneumothorax?

Answer 1

Air in the pleural space

Question 2

What are the different types of pneumothorax?

Answer 2

Spontaneous, traumatic, iatrogenic, lung pathology, tension

Question 3

What are risk factors for a pneumothorax?

Answer 3

Smoking, FH, male, tall and slender build, young age, presence of underlying lung disease

Question 4

What is normal intrapleural pressure?

Answer 4

Negative

Question 5

What happens in a pneumothorax?

Answer 5

Air flows in to close gradient

Question 6

How does a pneumothorax present?

Answer 6

Stable patient, sudden onset pleuritic chest pain, dyspnoea, cough

Question 7

What is the first line investigation?

Answer 7

CXR

Question 8

What would you see on a CXR?

Answer 8

Reduced/absent lung markings between lung margin and chest wall, visible rim between lung margin and chest wall

Question 9

When would you do US?

Answer 9

If patient immobile

Question 10

When would you do CT?

Answer 10

If CXR uncertain

Question 11

What other tests would you do?

Answer 11

Clotting, ABG

Question 12

What is a small primary spontaneous PTX?

Answer 12

Visible rim is 2cm or smaller

Question 13

How do you manage a small primary spontaneous PTX with no SOB?

Answer 13

Consider discharge and follow up CXR in review

Question 14

How do you manage a large primary spontaneous PTX and/or SOB?

Answer 14

Needle aspiration, if not <2cm on repeat CXR insert chest drain and supplemental O2 if needed, admit

Question 15

How do you manage a secondary PTX?

Answer 15

Chest drain if large, needle aspiration if small, admit and high flow O2

Question 16

What is a tension pneumothorax?

Answer 16

A one way valve mechanism, air enters pleural space but cannot exit

Question 17

What happens in a tension PTX?

Answer 17

Collapse of ipsilateral lung and compression of contralateral trachea, heart and other structures

Question 18

How does tension PTX present?

Answer 18

Cardiopulmonary deterioration, severe chest pain

Question 19

How does cardiopulmonary deterioration present?

Answer 19

Hypotension, respiratory distress, low sats, tachycardia, shock

Question 20

What would you find on examination in tension PTX?

Answer 20

Tracheal deviation to contralateral side, ipsilateral reduced breath sounds, hyperresonance on percussion, hypoxia

Question 21

How do you manage a tension PTX not due to trauma?

Answer 21

Put out cardiac arrest call, start high flow O2, immediate decompression

Question 22

How do you manage a tension PTX due to trauma?

Answer 22

Insert a large bore cannula into the pleural space through the second intercostal space in the mid-clavicular line

Question 23

What sound confirms diagnosis?

Answer 23

Hiss sound