Pneumothorax

Question 1

Types of pneumothorax

Answer 1

Closed: intact chest wall air leaks from lung into pleural space
Open: defect in chest wall
Tension: Air enters through 1 way valve cannot escape - mediastinal compression

Question 2

Causes of pneumpthorax

Answer 2

1. Spontaneous:
   - Primary: no underlying lung disease: young, thin men (ruptured subpleural bulla), smokers
   - Secondary: underlying lung disease e.g. COPD, Marfan’s, Ehler’s Danlos, Pulmonary fibrosis, sarcoidosis
2. Trauma
3. Iatrogenic: e.g. Subclavian CVP line insertion

Question 3

Symptoms of pneumothorax

Answer 3

Sudden onset
Dyspnoea
Pleuritic chest pain
Tension: respiratory distress, cardiac arrest

Question 4

Signs of pneumothorax

Answer 4

Chest:
↓ expansion
Resonant percussion
↓ breath sounds
↓VR
Tension: ↑JVP, mediastinal shift, ↑HR, ↓BP 
Crepitus: surgical emphysema

Question 5

Investigations for pneumothorax

Answer 5

ABG
US
CXR

Question 6

Tension pneumothorax treatment

Answer 6

Resuscitate pt.
No CXR
Large bore Venflon into 2nd ICS, mid-clavicular line
Insert chest drain

Question 7

Traumatic pneumothorax treatment

Answer 7

Resuscitate pt.
Analgesia: e.g. morphine
3-sided wet dressing if sucking
Insert ICD

Question 8

Primary pneumothorax treatment

Answer 8

No SOB/<2cm - consider discharge

SOB/>2cm - aspirate (chest drain if unsuccessful)

Question 9

Secondary pneumothorax treatment

Answer 9

SOB/>2cm/>50yrs - insert chest drain

If none of the above aspirate and admit for 24hrs