Pneumothorax

Question 1

What is a pneumothorax

Answer 1

process by which an abnormal amount of air accumulates within the pleural space

Question 2

What are risk factors of pneumothorax

Answer 2

Pre-existing lung disease

connective tissue disease

ventilation , including non-invasive ventilation

Question 3

What is a catamenial pneumothorax

Answer 3

pneumothorax that occurs at the time of menstruation

thought to be caused by endometriosis within the thorax

Question 4

How may someone with a pneumothorax present

Answer 4

SUDDEN ONEST

dyspnoea
pleuritic chest pain
sweating
tachypnoea
tachycardia
hyperresonance on percussion
absent breath sounds
decreased tactile vocal fremitus

Question 5

What is first line investigation

Answer 5

CXR

Question 6

How do you classify spontaneous pneumothoraxes

Answer 6

Primary - absence of underlying lung disease

Secondary - in presence of underlying lung disease

Question 7

How do you manage primary pneumothorax

Answer 7

<2cm of air and no dyspnoea- DISCHARGE

> 2cm of air and/or dyspnoea -
ASPIRATION
- if this fails , insert chest drain

Question 8

How do you manage secondary pneumothorax

Answer 8

if air <1cm - give oxygen and admit for 24 hrs

air 1-2cm - pleural aspiration
fails , CHEST DRAIN

Patient >50 and air >2cm and/or dyspnoea - CHEST DRAIN

if chest drain fails - video assisted thoracoscopic surgery

Question 9

What is a tension pneumothorax

Answer 9

can occur following thoracic trauma when a lung parenchymal flap is created

acts as one way valve and pressure rises

trachea shifts and hyper-resonance and apparent on affected side

Question 10

How do you treat a tension pneumothorax

Answer 10

Emergency needle thoracentesis and chest tube insertion