Pneumothorax

Question 1

Definition of pneumothorax

Answer 1

air within the pleural space

Question 2

Causes of pneumothorax

Answer 2

1. Spontaneous
   - primary (tall thin young men)
   - 2ndary - underlying lug pathology
2. Tramautic
   - iatrogenic - VENTILATION
   - Non-iatrogenic - trauma

Question 3

Define compliance

Answer 3

measure of how the change in pressure can affect the change in volume, which is influenced by the distensibility of the lungs and the chest wall.

Compliance is inversely proportional to elastance.

Question 4

Mx of tension pneumothorax

Answer 4

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

immediate needle decompression –> 16-gauge cannula inserted at the 2nd intercostal space, mid-clavicular line, on the affected side.

Insert JUST ABOVE 3RD RIB –> avoid damaging the neurovascular bundle.

The needle decompression acts as a bridge before insertion of an intercostal chest drain.

Question 5

Mx of primary pneumothorax

Answer 5

Conservative
- NO SOB AND pneumothorax <2 cm. F/u in 2-4weeks in OPD

Aspiration with a 16-18G cannula under local anaesthetic
- SOB OR pneumothorax >2 cm
- If cannula fails –> IC drain

Question 6

Mx of 2ndary pneumothorax

Answer 6

Admit for observation + O2 therapy
- NO SOB AND pneumothorax <1 cm

Aspiration with a 16-18G cannula under local anaesthetic
- NO SOB AND pneumothorax 1-2 cm

IC drain + admission
- SOB OR pneumothorax >2 cm