Pneumothorax Flashcards
Pneumothorax Classification
- Primary spontaneous
- Secondary (associated with lung disease), consequences are greater and management is more difficult
Pneumothorax Point of Aspiration?
Through second or third anterior intercostal space
Pneumothorax Epidemiology
Peak in incidence in men under 20 then another peak at 60
In women, 30-34 then 60
Pneumothorax RFs
Smoking, Marfan’s, occurs during sedentary activity, endometriosis, FHx
Pneumothorax Presentation
- Symptoms may be minimal or absent for PSP
- Symptoms greater in SSP pneumothorax is smaller
- Sudden onset pain, breathlessness
- Tachypnoeic, tachycardia (PR>135 suggests tension)
- Pulsus paradoxus
- Hypotension, raised JVP
Pneumothorax Ix
- CXR
- USS (supine trauma)
- CT (complex or uncertain)
- ABG
Pneumothorax Differentials
-Pleural effusion, CP, Bornholm, PE
Pneumothorax Management
-Rule out tension
-Relieve dyspnoea
PSP
-If over 2cm and/or breathless; aspirate using 16-18G cannula
-If not consider discharge and outpatient review with written advice to return if pain or breathlessness
SSP
-If over 2cm and/or breathless; chest drain 8-14Fr, admit
-If 1-2cm; aspirate using 16-18G cannula, if unsuccessful; chest drain as above
-If less than 1-2cm or iatrogenic admit and give high flow oxygen
Pneumothorax Indications for a Chest Drain
- Any ventilated patient
- Tension pneumothorax after initial needle relief
- Persistent or recurrent pneumothorax after simple aspiration
- Large SSP in patients aged over 50 years
Pneumothorax Special Considerations
- Pregnancy; recurrence more common, less invasive strategies effective
- Catamenial; surgical intervention and hormonal treatment required
- HIV; early tube and surgical referral
- CF; aggressive treatment and early surgical referral
Pneumothorax Prognosis
- Death rare, recurrence high
- SSP worse
- Reducing risk factors reduces risk
- Air travel with radiologically confirmed resolution
