Pneumothorax

Question 1

Describe the management of primary spontaneous pneumothorax.

Answer 1

If not breathless and pneumothorax <2cm then discharge and review in 2-4 weeks

If either breathless or pneumothorax >2cm then aspirate using 16-18 gauge needle
Then, if still symptomatic or on repeat CXR pneumothorax is still >2cm, insert chest drain

Question 2

Describe the management of secondary spontaneous pneumothorax

Answer 2

If >2cm or breathless then insert chest drain

If 1-2cm and not breathless then aspirate using 16-18 gauge needle. Then if still >1cm then insert chest drain

If <1cm and not breathless then administer oxygen and monitor for 24 hours

Question 3

What advice should be given to patients post-pneumothorax?

Answer 3

Advised not to go diving unless definitive surgical pleurodesis has been performed

Advised not to take a flight until at least 1 week post-resolved pneumothorax as confirmed by CXR

Smoking cessation advice

Question 4

What are the potential signs and symptoms of tension pneumothorax?

Answer 4

Hypertension
Respiratory distress
Hypoxia
Tachycardia
Shock
Loss of consciousness
Severe chest pain
Sweating