Pneumothorax

Question 1

Pneumothorax

Answer 1

Breach in the visceral pleura allowing air to escape from the lungs into the pleural cavity.
This causes the lung to deflate towards the hilum.

Question 2

Small pneumothorax

Answer 2

If the space is <2cm

Question 3

Large pneumothorax

Answer 3

If the space is >2cm

Question 4

Clinical presentation

Answer 4

Can be assymptomatic
Common in tall, thin young men Sudden onset pleuritic chest pain
Acute breathlessness

Question 5

Clinical signs

Answer 5

Tachypnoea
Tachycardia
Reduced ipsilateral chest expansion 
Trachea deviation away from pneumothorax
Hyper ressonant percussion note 
Reduced breath sounds

Question 6

Investigations

Answer 6

CXR - absent lung markings (black areas), outline of lung visible
Ultrasound
CT scan - in uncertain cases

Question 7

Management of small pneumothorax

Answer 7

Assymptomatic - no treatment

Symptomatic - cannula, venflon, aspirate

Question 8

Management of large pneumothorax

Answer 8

1. Needle aspiration (thoracentesis) into the mid portion of the ICS
2. Chest drain insertion
   * BOTH PROCEDURES VIA 4th/5th ICS MID AXILLARY LINE*

Question 9

Tension pneumothorax

Answer 9

Air enters pleural cavity through breach in visceral pleura during inspiration but air doesn’t escape during expiration.
Pneumothorax continues to expand and lung collapses towards its root.
Build up of air applies pressure to the mediastinal structures resulting in mediastinal shift which reduces the venous return to the heart (hypotension, raised JVP)

Question 10

Management of tension pneumothorax

Answer 10

Medical emergency
Insert large bore IV cannula into pleural cavity via 2nd ICS mid clavicular line - to release air from the pleural space
Then insert a chest drain