13. Treatment and diagnosis of hemo- and pneumothorax

Question 1

How can you diagnose pneumothorax?

Answer 1

Symptoms:
* sudden breathlesness
Signs:
* decreased breath signs
* hypertympanic percussion

Radiology:
* X-ray

Question 2

What are the types of pneumothorax?

Answer 2

Spontaneous
* primary (absent chronic underlying lung disease, seen in marfan)
* secondary (COPD, cystic fibrosis, asthma)

Traumatic
* Non-iatrogenic (penetrating trauma, blunt trauma)
* Iatrogenic (thoracocentesis, iv centrla line, chest surgery, trans-thoracic needle aspiration)

Question 3

How can you treat pneumothorax?

Answer 3

< 2 cm → resolves spontaneously
Needle aspiration (second intercostal space)
tube thoracostomy

Surgical if persists (>4days) , after 2nd event, if bilateral, tension ptx
- PLEUROdesis: obliterate pleural space by use of doxycyclin or talc to prevent recurrences

Question 4

How can you diagnose hemothorax?

Answer 4

Symptoms:
* sudden breathlesness
Signs:
* decreased breath signs
* dull percussion

Radiology:
* X-ray (seen when < 200ml volume)

Question 5

How can you treat hemothorax?

Answer 5

Tube thoracostomy (multiple) (4th or 5th intercostal space)
Surgery if bleeding persists after tube thoracostomy (artery bleeding)

Question 6

Do you go above or below the ribs, when puncturing?

Answer 6

ABOVE (NO VESSELS)