Pneumothorax

Question 1

When does a pneumothorax occur?

Answer 1

When air enters the pleural space
They can be spontaneous or secondary to trauma, medical intervention or lung pathology

Question 2

What is the typical presentation of a pneumothorax?

Answer 2

Tall, thin young man
Sudden breathlessness
Pleuritic chest pain

Question 3

What are the causes of a pneumothorax?

Answer 3

Spontaneous
Trauma
Iatrogenic
Lung pathologies such as in GFR toon, asthma or COPD

Question 4

What are investigations done?

Answer 4

Erect chest X-ray
CT thorax if pneumothorax is too small

Question 5

What is the management of a patient with high-risk characteristics?

Answer 5

Chest drain

Question 6

What is seen as a lower risk patient?

Answer 6

<2cm

Question 7

How are lower risk patients treated?

Answer 7

More conservatively

Question 8

What is management of lower risk patient based on?

Answer 8

Procedure avoidance- conservative management
Rapid symptom relief with ambulatory care - pleural vent ambulatory device
Rapid symptom relief with short term drainage - needle aspiration or chest drain

Question 9

What is a pleural vent ambulatory device?

Answer 9

Involves a catheter inserted into pleural space attached to device stuck to upper chest
-allows air to exit without re-entry
-can be worn outpatient

Question 10

Where is a chest drain inserted?

Answer 10

Inserted into triangle of safety
-5th intercostal space
-midaxillary line
-anterior axillary line

Question 11

What are the complications of chest drains?

Answer 11

Air leaks
Surgical emphysema

Question 12

When is surgical management required?

Answer 12

Chest drain fails to correct pneumothorax
Persistent air leaks in drain
Reoccurrence

Question 13

What is a tension pneumothorax?

Answer 13

Trauma to chest -> one way valve that lets air in but not out of pleural space
With each breath, more air leaks in pleural space
Creates pressure -> push mediastinum across the-> kink big vessels in mediastinum -> cardio respiratory arrest

Question 14

What are the signs of a tension pneumothorax?

Answer 14

Tracheal deviation away from side of pneumothorax
Decreased air entry on affected side
Increase percussion resonance
Tachycardia
Hypotension

Question 15

What is the management of a tension pneumothorax?

Answer 15

Insert a large bore cannula into the second intercostal space in midclavicular line