Pneumothorax

Question 1

What is the difference between a primary and secondary pneumothorax? Who does each affect?

Answer 1

Primary - occurs in the absence of underlying lung disease. Often in the young. Less serious.
Secondary - occurs with underlying lung disease. Espec COPD.

Question 2

When diagnosing, what are the key questions that you should ask? (5)

Answer 2

"When did the chest pain start?"
"Have you ever had one before?"
"Any rare diseases?" (Marfans etc)
"Any recent trauma or procedures?"
"Any underlying lung disease?" (eg COPD)

Question 3

What are the key symptoms?

Answer 3

Sudden onset chest pain

Shortness of breath

Question 4

What are the main risk factors?
History (1)
Type of person (4)
Other conditions (7)

Answer 4

Previous pneumothorax
Male
Tall
Thin
Smoker (20-40 py)
Connective tissue disorders: Marfans, Ehlers-Danlos
Emphysematous bullae
TB, occupational lung disease, asthma

Question 5

What are the key clinical signs?

If tension pneumothorax?

Answer 5

Reduced expansion on one side
Hyper-resonant percussion
Reduce breath sounds
Tension - tracheal deviation

Question 6

What are the 3 key differentials?

Answer 6

PE
Pneumonia
Emphysematous bullae

Question 7

What is the treatment for a tension pneumothorax?

Answer 7

Insert cannula immediately

Question 8

In a non tension pneumothorax, what is the treatment?

Answer 8

High flow oxygen via non-rebreathe bag
If patient is well and pneumothorax < 2 cm - monitor
If patient unwell/pneumothorax > 2 cm - chest drain or aspirate

Question 9

What are the key investigations for diagnosis?

Answer 9

CXR

CT if CXR is not clear (e.g. if unable to distinguish between bullae and pneumothorax)

Question 10

What tests should you order in case of a suspected pneumothorax?

Answer 10

FBC, CRP, U+E, LFT
ABG, if hypoxic, SOB or unwell
CXR
ECG

Question 11

When is it dangerous to insert a chest drain?

Answer 11

If you are actually inserting into a bullus