pneumothorax

Question 1

what

Answer 1

air gets into pleural space and separates lung from chest wall

Question 2

typical patient

Answer 2

young, tall thin young man
presenting with:
sudden breathlessness
pleuritic chest pain

Question 3

causes

Answer 3

spontaneous
trauma
iatrogenic: lung biopsy, mechanical ventilation, central line insertion
lung pathology: infection, asthma, COPD

Question 4

Ix of choice

Answer 4

erect CXR

Question 5

CXR findings

Answer 5

area between lung tissue and chest wall where no lung markings

Question 6

Mx: no SOB and <2cm rim of air

Answer 6

no treatment required as will spontaneously resolve

follow up in 2-4wks

Question 7

Mx: SOB and/or >2cm rim of air

Answer 7

aspiration and reassessment

Question 8

Mx - aspiration fails twice

Answer 8

chest drain

Question 9

Mx - pt unstable or bilateral or 2ry pneumothorax

Answer 9

chest drain

Question 10

tension pneumothorax

Answer 10

caused by trauma to chest wall that created a one way valve - lets air into pleural space but not out

Question 11

tension pneumothorax - why dangerous

Answer 11

one way valve means air is drawn in during inspiration and then trapped

created pressure in pneumothorax and will push mediastinum across and kink the big vessels

Question 12

tension pneumothorax signs

Answer 12

trachael deciation 
reduced air entry 
inc resonance
tachycardia
hypotension

Question 13

tension pneumothorax Mx

Answer 13

insert a large bore cannula into 2nd interocostal space in midclavicular line

once pressure releived - chest drain

Question 14

chest drain: triangle of safety

Answer 14

• 5th ICS
• mid axillary line
• anteior axillary line