Pneumothorax

Question 1

Pneumothorax definition

Answer 1

• air within the pleural space
• primary if occurring in people without known respiratory illness
• secondary if respiratory illness present
• tension usually results from trauma

Question 2

Pneumothorax risk factors

Answer 2

• smoking
• pre-existing lung disease
• Marfan’s syndrome
• rheumatoid arthritis
• ventilation, including non-invasive

Question 3

Pneumothorax pathophysiology

Answer 3

• spontaneous
• trauma
• iatrogenic
• lung pathology
• catamenial - menstruation

Question 4

Pneumothorax signs and symptoms

Answer 4

• shortness of breath
• chest pain, often pleuritic
• sweating
• increased heart rate and resp rate
• tension - reduced breath sounds, tracheal tug may be present

Question 5

Pneumothorax investigations

Answer 5

• chest X-ray
• if tension, manage as emergency

Question 6

Primary pneumothorax management

Answer 6

• if rim of air < 2cm and no shortness of breath, follow up in 2-4 weeks
• otherwise admit and attempt aspiration
• if this fails consider a chest drain

Question 7

Secondary pneumothorax management

Answer 7

• if rim of air < 1cm and no shortness of breath, give oxygen and admit for 24h
• if rim of air 1-2 cm and no shortness of breath, admit and attempt aspiration
• if over 50 or rim > 2cm or shortness of breath, insert chest drain
• if no resolution, refer for video-assisted thorascopic surgery or mechanical /chemical pleurodesis ± bullectomy

Question 8

Tension pneumothorax management

Answer 8

• large bore cannula
• insert into second intercostal space, mid-clavicular line
• once pressure relieved, insert chest drain