Pneumothorax

Question 1

What is a Pneumothorax

Answer 1

Air in pleural space

Question 2

Types of Pneumothorax

Answer 2

1. Primary Spontaneous Pneumothorax (no cause)
2. Secondary Pneumothorax (due to)
   Asthma
   Emphysema
   RTA

Question 3

C/F of Pneumothorax

Answer 3

Symptoms:
SOB
Pleuritic chest pain

Signs:
Decreased breath sounds
Hyper-resonant on percussion
Circulatory shock (TP)
Raised JVP (TP)
Apex beat shift - tension Pneumothorax

Xray:
Tracheal deviation esp in tension Pneumothorax
Broncho-vascular markings decreased

Question 4

MX of Primary Spontaneous Pneumothorax (PSP)

Answer 4

Small (<15% air in chest cavity/<2cm air rim), Asymptomatic - Observe

Large, Asymptomatic - Observe

Large, <95%O2 sat - Oxygen

Small/Large, symptoms+ … Aspiration (2nd intercostal space)

Intercostal drainage tube
If >3L on aspiration or
>15% air after 2-4 hrs of aspiration

Question 5

MX of Secondary Pneumothorax

Answer 5

If >15%, >50yrs, smoking/lung disease, rim of air on CXR >2cm
Directly go for chest drainage tube

if not or air rim 1-2cm .. aspiration … not improving … Chest drainage tube

Observe for 24hrs

Question 6

Mx of Tension Pneumothorax

Answer 6

Needle thoracostomy immediately

Question 7

Traumatic pneumothorax

Answer 7

Chest tube if - symptomatic/large
1. Gen anaesthesia
2. Intubation and ventillation (PPV with tube thoracostomy)
3. Transport via air support

Question 8

Open pneumothorax mx

Answer 8

Partial occlusive dressing (3sides taped)
Tube thoracostomy