Pneumothorax

Question 1

What is pneumothorax?

Answer 1

Air in pleural space, could be spontaneous, secondary to trauma, iatrogenic or lung pathology

Question 2

Typical patient with pneumothorax?

Answer 2

Young tall thin man with sudden breathlessness and pleuritic chest pain, whilst playing sports. May be sweating tachypnoea and tachycardia

Question 3

Causes of pneumothorax?

Answer 3

Spontaneous
Trauma
Iatrogenic: lung biopsy, mechanical ventilation, central line insertion
Lung pathology: infection asthma or COPD, cystic fibrosis, marfans RA
Catamenial pneumothorax- endometriosis in thorax

Question 4

How to diagnose a pneumothorax?

Answer 4

Erect CXR for simple

Question 5

How to measure size of pneumothorax?

Answer 5

Horizontally fro edge of lung to inside of chest wall at level of hilum

Question 6

If you cant see pneumothorax on CWR what should you do?

Answer 6

CT thorax

Question 7

How manage primary pneumothorax?

Answer 7

1. If no sob and less than 2 cm- no treatment will resolve follow up in 2-4 weeks
2. If sob and or >2cm- aspiration and reassessment
   If aspiration fails twice then chest drain
   Most will require chest drain if secondary or bilateral, or unstable patient

Question 8

What is tension pneumothorax?

Answer 8

One way valve letting air in but not out. This will push the mediastinum across and possibly cause cardio respiratory arrest

Question 9

Signs of tension pneumothorax?

Answer 9

Increased resonance to percussion
Reduced air entry to affected side
Tracheal deviation away from side of pneumothorax
Hypotension
Tachycardia

Question 10

Management of tension pneumothorax?

Answer 10

Insert a large bore cannula into 2nd intercostal space in the midclavicular line, when pressure is relieved then chest drain

Question 11

Chest drain margins?

Answer 11

Trainable of safety: 5th intercostal space, midaxillary line. And anterior axillary line
Needle inserted above rib. Get CXR to see positioning of chest drain.

Question 12

How to manage secondary pneumothorax?

Answer 12

1. If patient over 50, >2cm and or sob then chest drain
2. If between 1-2cm then aspirate. If this fails then chest drain

Question 13

If patient has persistent pneumothoraces or insufficient lung reexpansion?

Answer 13

Video assisted thoracoscopic surgery- pleurodesis and bullectomy

Question 14

Fitness to fly in pneumothorax?

Answer 14

2 weeks after successful drainage/ 1 week after post check X ray

Question 15

Can they go scuba diving?

Answer 15

No unless undergone bilateral surgical pleurectomy with normal lung function and CT scan