Pneumothorax

Question 1

What is a pneumothorax?

Answer 1

Air in the pleural space
Occurs spontaneously

Secondary to:
Trauma
Lung pathology (asthma, COPD, infection)
Iatrogenically (lung biopsy, ventilation, central line insertion)

Question 2

First line investigation for pneumothorax

Answer 2

Erect chest Xray

Question 3

What is seen on CXR in pneumothorax?

Answer 3

Area between lung tissue and chest wall where there are no lung markings (black)

Line demarcating edge of lung where pneumothorax begins

Question 4

Management of pneumothorax

Answer 4

No SOB and <2cm rim - no treatment, follow up 2-4 weeks

SOB and/or >2cm rim - aspiration required

If aspiration fails twice - chest drain needed

Bilateral or secondary pneumothoraces or unstable patient usually requires chest drain

Question 5

Signs of tension pneumothorax (5)

Answer 5

Tracheal deviation away from side of pneumothorax
Reduced air entry to affected side
Increased resonant to percussion on affected side
Tachycardia
Hypotension (cardiac outflow obstruction)

Question 6

Management of tension pneumothorax

Answer 6

Large bore cannula into the second intercostal space, midclavicular line

Question 7

Where is a chest drain inserted?

Answer 7

5th intercostal space
mid axillary line

Chest xray once inserted