pneumothorax

Question 1

pneumothorax discharge

Answer 1

following needle aspiration in primary spontaneous pneumothorax could be considered for discharge. I would discuss this with my Registrar or Consultant however, before I agreed to the discharge.

but should be counselled about the chances of recurrence and I would safety net

I would advise the patient to immediately return to hospital if symptoms recur as the pneumothorax can recur despite treatment.

I would also arrange a follow up and repeat x-ray in 2-4 weeks in the Respiratory Clinic or Ambulatory Care Unit depending on the hospital policy.

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All patients should be admitted for at least 24 hours

if the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours

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British Thoracic Society not travelling by air for a period of 1 week post check x-ray

Question 2

primary pneumothorax tx?

Answer 2

rim of air is < 2cm and the patient is not short of breath/ chest pain then discharge should be considered

otherwise, needle aspiration should be attempted

if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted

Question 3

secondary pneumothorax tx?

Answer 3

patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain should be inserted.

otherwise aspiration should be attempted if the rim of air is between 1-2cm.
If aspiration fails (i.e. pneumothorax is still greater then 1cm) a chest drain should be inserted.