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Question 1

What is the procedure for managing a patient with pneumothorax?

Answer 1

Avoidance of intervention if the patient is asymptomatic.

Regular review as outpatient (every 2-4 days) or inpatient if stable.

Question 2

What are high-risk characteristics for pneumothorax?

Answer 2

1. Haemodynamic compromise (tension pneumothorax)
2. Significant hypoxia
3. Bilateral pneumothorax
4. Underlying lung disease
5. Age ≥ 50 years with significant smoking history
6. Haemopneumothorax

Question 3

What should be done if the patient is symptomatic?

Answer 3

Assess if the pneumothorax is of sufficient size to intervene.

Pneumothorax of sufficient size usually ≥ 2cm laterally or apically on CXR, or any size on CT scan.

Question 4

What is the main priority for the patient?

Answer 4

Rapid symptom relief, either ambulatory or through short-term drainage.

Take into account patient preference and local availability.

Question 5

What are the options for intervention?

Answer 5

1. Ambulatory device
2. Needle aspiration
3. Chest drain

Question 6

What is the follow-up procedure after intervention?

Answer 6

Regular review as outpatient (every 2-3 days) or inpatient (daily).

At review, if enlarging pneumothorax or symptoms consider chest drain insertion and admission.

Question 7

When should the device be removed?

Answer 7

Remove the device when the pneumothorax is resolved.

Success is defined as improvement in symptoms and sustained improvement on CXR.

Question 8

What should be done if the patient is stable after intervention?

Answer 8

Follow-up in OPD in 2-4 weeks.

Discharge and review in OPD in 2-4 weeks.

Question 9

What is a consideration for high-risk patients with pneumothorax?

Answer 9

Talc pleurodesis can be considered on the first episode of pneumothorax in high-risk patients.

Especially in those where repeat pneumothorax would be hazardous (e.g., severe COPD).