Pneumothorax

Question 1

Which A-E?

Answer 1

Breathing

Question 2

Airway

Answer 2

Question 3

Breathing

Answer 3

Look: unequal chest expansion, tripoding, accessory muscle use
Listen: decreased breath sounds
Feel: uneven expansion, tracheal deviation, hyperresonance on percussion

RR, O2

ABG stat - PaO2 and lactate
XCR to see lobar colapse and pneumothorax

Primary: congenital weakness of a pleural bleb
Secondary:
- lung disease : COPD, TB, sarcoid
- Iatrogenic: pleural aspiration, Biopsy, central line
- Trauma

Management:

Primary > 2 cm and/or breathless:
* 15 L O2 via NRB
* needle decompression stat (triangle of safety, lattisimus dorsi, pec major, and axilla) 16 gauge syring

Secondary > 2 cm or breathless
* Chest drain 8-14 fr admit

Size 1-2cm
* Aspirate 16-18G cannula

Question 4

Circulation

Answer 4

Look: anaemia, cyanosis
Listen: S1,2
Feel: CRT, pulse

BP, HR (tachycardia), raised JVP
Do ECG to rule out PE

Cannulae
Bloods: FBC, UEs, LFTs, CRP

Question 5

Tension pneumo

Answer 5

• 2222
• Large bore 14-16 G needle with syringe filled with 0.9% saline into safe triangle

(14G yellow, 16 G grey, 18G green)
* Remove plunger to allow trapped air through syringe
* XCR
* Chest drain