PNEUMOTHORAX

Question 1

DOCUMENTATION

Answer 1

Acute onset pleuritic chest pain and shortness of breath

May become dull and constant

Tachycardia - most common exam finding

Decreased ipsilateral breath sounds

Hyperesonance to percussion

Question 2

MANAGEMENT

Answer 2

IMAGING

PA CXR - primary diagnostic modality

No clear benefit for expiratory film

Deep sulcus sign

US - sn 98%, sp 99%

LARGE PNEUMOTHORAX: DEFINITION
Apex-cupola distance > 3 cm (ACCP)

MANAGEMENT: CONSERVATIVE
1. Age < 50
2. PSP
3. Mildly Symptopmatic: pain controlled, able to mobilize, vital signs within normal limits
4. Reliable
5. No planned air travel
OR
Small (< 3 cm) Primary Spontaneous, minimal symptoms:
NRB
Repeat CXR in 3-6 hours

MANAGEMENT: CHEST TUBE
Unstable
SSP

Traumatic:
Chest tube in all patients unless occult or small and asymptomatic with no concern for hemothorax

Large (>/ 3 cm) Primary Spontaneous: Symptomatic, Age > 50
Aspiration
OR
Chest tube

Small (<3 cm) Secondary Spontaneous:
Aspiration
OR
Chest tube

Large (>/ 3 cm) Secondary Spontaneous:
Chest tube

Question 3

PIGTAIL CATHETER PLACEMENT

Answer 3

1. Landmark
2. Local Anesthetic
3. Set-up Equipment
4. Introduce Seeker Needle
5. Insert Guidewire
6. Nick Skin
7. Dilate Skin
8. Insert Pigtail Catheter
9. Intrapleural Block
10. Attach Valve
11. Suture
12. Confirm Air Leak
13. Tape To Chest Wall