PNEUMOTHORAX

Question 1

define pneumothorax

Answer 1

Air in the pleural space causing collapse of part or all of a lung.

Question 2

What can cause a pneumothorax?

Answer 2

 Spontaneous
Primary: no underlying lung disease
Secondary: underlying lung disease

	Trauma
	Iatrogenic trauma
	Infection eg TB, pneumonia, lung abscess
	Carcinoma 
	Congenital eg Marfan’s syndrome

Question 3

investigations

Answer 3

CXR

Question 4

treatment and management

Answer 4

 Nothing, just observe (may resolve spontaneously)
 Chest drainage: aspiration or ICC (intercostal catheter) with underwater seal
 Pain relief and oxygen

Question 5

how do they happen?

Answer 5

Increased intra-pleural pressure reduces lung inflation.

Question 6

signs and symptoms

Answer 6

 Acute dyspnoea
 Dry cough
 Pleuritic chest pain
 Can be asymptomatic if it is small

Question 7

who are they more likely to happen in?

Answer 7

More common in smokers due to emphasematous changes, Marfan’s, people with a family history or past history, and tall skinny young males.

Question 8

what could you find on examination?

Answer 8

 High RR and low O2 sats
 Reduced breath sounds on affected side
 Reduced chest expansion on affected side
 Pain on inspiration
 Hyper-resonant to percussion

Question 9

what are some complications?

Answer 9

TENSION PNEUMOTHORAX
Medical Emergency! This occurs when the pressure in the pleural space shifts the mediastinum so that venous return is compromised. Trachea may be deviated to the contralateral side, however, beware bilateral tension pneumonthorax where the trachea may be midline. Requires prompt decompression to avoid cardiac arrest.

RECURRENT PNEUMOTHORACES
May require surgery (apical bullectomy) or pleurodesis with sclerosing agent.

Question 10

what is a contraindication in someone with a pneumothorax?

Answer 10

POSITIVE PRESSURE VENTILATION is contraindicated as it can exacerbate the amount of air trapped in the pleural space and worsen the pneumothorax. Mechanically ventilated patients may present with hypoxia or an increase in ventilation pressures.