Pneumothorax

Question 1

what is pneumothorax

Answer 1

air within the pleural cavity

Question 2

what is a haemothorax

Answer 2

blood within the pleural cavity

Question 3

what is chylothorax

Answer 3

lymph within the pleural cavity

Question 4

what are the causes of a pneumothorax

Answer 4

spontaneous and traumatic

Question 5

what is a spontaneous pneumothorax and what may have caused it

Answer 5

it is pneumothorax that occurs in patients with normal lungs.

usually occurs in tall, thin men

Question 6

what is secondary pneumothorax

Answer 6

Occurs in patients with pre-existing lung disease (e.g. COPD, asthma, TB)

Question 7

what is traumatic pneumothorax

Answer 7

penetrating injury to the chest; can be through cannulating the JV

Question 8

what are some risk factors for pneumothorax

Answer 8

Collagen disorders (e.g. Marfan’s syndrome, Ehlers-Danlos syndrome)

Question 9

epidemiology of pneumothorax

Answer 9

4x more common in males

mainly 20-40 yr olds

Question 10

presenting symptoms of pneumothorax

Answer 10

Sudden-onset breathlessness

Pleuritic chest pain

Distress with rapid shallow breathing in tension pneumothorax

Question 11

presenting symptoms of a tension pneumothorax

Answer 11

patients are distressed with rapid laboured respirations, cyanosis, profuse diaphoresis, and tachycardia.

Question 12

signs on physical examination of pneumothorax

Answer 12

ipsilateral reduced breath sounds

ipsilateral reduced chest expansion

hypoxia

ipsilateral reduced tactile vocal fremitus

ipsilateral hyperresonance on percussion

Question 13

what happens to the trachea in a tension pneumothorax

Answer 13

the trachea will shift towards the opposing side of the pneumothorax (contralateral deviation)

Question 14

signs of tension pneumothorax

Answer 14

tachycardia, hypotension, contralateral tracheal deviation

Question 15

investigation for pneumothorax

Answer 15

CXR and ABG (hypoxia)

Question 16

what findings will you see on a CXR

Answer 16

It will show a dark area of film with no vascular markings

Fluid level may be seen if there is any bleeding

Question 17

management of a pneumothorax

Answer 17

The patient should be approached using the ABCDE algorithm. High flow oxygen (15 L/min) via a non-rebreather mask should be administered.

Emergency management is with immediate needle decompression using a 16-gauge cannula inserted at the second intercostal space, mid-clavicular line, on the affected side.

Note that the needle should be inserted just above the third rib, to avoid damaging the neurovascular bundle. The needle decompression acts as a bridge before insertion of an intercostal chest drain.