Pneumothorax

Question 1

If the patient is older than 50, has a significant smoking history and evidence of underlying lung disease. Is it more likely to be a primary or secondary pneumothorax?

Answer 1

Secondary

Question 2

In a secondary pneumothorax when would you proceed to chest drain?

Answer 2

If rim of air on CXR > 2cm

Or S.O.B

Question 3

Treatment of a secondary pneumothorax which you are able to aspirate?

Answer 3

Admit
High flow oxygen (unless COPD)
Observe for 24 hours

Question 4

When do you aspirate a primary pneumothorax?

Answer 4

Size > 2cm and/or breathless

Question 5

Treatment of primary pneumothorax if aspiration is unsuccessful

Answer 5

Chest drain

Question 6

Treatment of primary pneumothorax if aspiration is successful

Answer 6

Consider discharge

Review in 2-4 weeks

Question 7

Signs of tension pneumothorax

Answer 7

Respiratory distress 
Tachycardia 
Hypotension 
Distended neck veins 
Tracheal deviation (away from pneumothorax) 
Increased percussion note 
Reduced air entry on affected side

Question 8

Treatment of tension pneumothorax

Answer 8

Large bore needle into 2nd intercostal space midclavicular line
(Do this before requesting CXR)
Then insert chest drain

Question 9

Ina spontaneous pneumothorax in which 2 situations do you proceed immediately to chest drain

Answer 9

If bilateral or haemodynamically unstable