Chest Discomfort Scheme
Acute Dyspnea Scheme
What is a Pneumothorax?
When air becomes trapped between the visceral and parietal pleura in the lungs.
Signs and Symptoms of Pneumothorax
Hyperresonance (full of air)
Tracheal shift (if big and collapses lung)
Diagnosis of Pneumothorax
Notice the areas of hyperlucency.
Classification of Pneumothorasx
Primary - spontaneous with no underlying disease
Secondary - have an underlying disease such as COPD, pulmonary fibrosis, HIV
Iatrogenic - we did this... often when placing a subclavean catheter or pacemaker wire
Traumatic - often in conjunction with a rib fracture
Has high recurrence rates of about 30-40% after the first presentation, and about 50% after the second presentation.
Never allowed to scuba dive.
Risk Factors for Primary Pneumothorax
Management of Pneumothorax
1. Ensure patient stability - ABCs and oxygen
2. Management of air in the pleural space
3. Prevent recurrence
Management of Pleural Air
When to Treat Pneumothorax
You must treat pneumothorax when...
It is symptomatic and large primary pneumothorax (>2-3cm... This will reduce lung volume by up to 50%)
Patient is experiencing breathlessness
When to Remove a Chest Tube
#1 - when the air has been evacuated (lung is up on CXR)
#2 - when there is no more air leaking out. Often you will clamp the lung shut for 2-4 hours and do a repeat CXR.
When the intrapleural pressure exceeds atmospheric pressure. This occurs because of essentially a one-way valve on inspiration where air continues to get into the pleural space. This pushes the mediastinum to the opposite side.
This is a medical emergency.
This needs to be decompressed with a large bore needle in the 2nd intercostal space and afterwards a chest tube and waterseal placed.
A surgical procedure to remove a bulla or bleb.
A when these bullae or blebs rupture, it can cause a primary pneumothorax.