Pleural diseases: pneumothorax (R1)

Question 1

Describe the pathophysiology of pneumothorax

Answer 1

Question 2

What are the 3 types of pneumothoraces?

Answer 2

Spontaneous pneumothorax
Traumatic pneumothorax
Tension pneumothorax

Question 3

Spontaneous pneumothorax
- Pathophysiology?
- Two types?

Answer 3

Question 4

Primary spontaneous pneumothorax
- Are there any underlying conditions?
- Often a ____, ____ [sex] holding their breath.
- Does it usually subside spontaneously?
- Is there a risk of recurrence?

Answer 4

No
Tall, thin, male
Yes - air is reabsorbed
Yes

Question 5

Secondary spontaneous pneumothorax
- Are there any underlying lung conditions?
- Examples?

Answer 5

Yes
Emphysema, asthma, TB

Question 6

Tension pneumothorax
- Can they be either spontaneous or traumatic?
- What is the pathophysiology of tension pneumothoraces?
- Is it a medical emergency?

Answer 6

Yes

Question 7

Risk factors?

Answer 7

• Have you or anyone in your family had a collapsed lung?
• Do you have any lung conditions?
• Do you smoke? Use inhaled drugs?
• Have you had any trauma to your chest?

Question 8

History

Answer 8

Sudden onset pleuritic chest pain + SOB

Question 9

Exam findings
- Vital signs
- Neck
- Heart
- Lungs

Answer 9

Question 10

Investigations?

Answer 10

CXR

Question 11

CXR
- Findings in all pneumothoraces?
- Specific finding in tension pneumothorax?

Answer 11

Lung markings don’t reach the outer rib margin + outline of collapsed lung can be seen
Tension: displacement of trachea and heart, away from affected side.

Question 12

Management
- 3 overall principles?

Answer 12

• Respiratory support
• Assess patient stability
• Remove fair

Question 13

Management
- Respiratory support?

Answer 13

High flow oxygen (target SpO2 >=96-100%)
Sit upright

Question 14

Management: removing air
- Spontaneous pneumothoracies?

Answer 14

Question 15

Management: removing air
- Traumatic pneumothorax?

Question 16

Management: removing air
- Tension pneumothorax?

Answer 16

Emergency needle thoracostomy (or finger thoracostomy if unsuccessful)
Followed by chest tube placement

Question 17

Management: removing air
- Bilateral pneumothorax
- Requires mechanical ventilation
- Otherwise unstable

Answer 17

Emergency chest tube placement