Pneumothorax

Question 1

What is a tension pneumothorax?

Answer 1

Tension pneumothorax is air in the pleural cavity under positive pressure.

Question 2

What are the clinical features of pneumothorax?

Answer 2

1. Chest pain - acute onset, increases with inspiration
2. Dyspnea
3. Anxiety, fatigue
4. Diaphoresis
5. Cyanosis
6. Tachypnea, tachycardia, pulsus paradoxus, hypotension, CV collapse
7. Distant/absent breath sound, percussion reveals hyper-resonance
8. Ventilator - high-peak airway pressures, decreased tidal volume

Question 3

What is the differential diagnosis of pneumothorax?

Answer 3

1. Spontaneous pneumothorax (no underlying lung disease) - cigarette smokers, marfan syndrome, pregnancy
2. Secondary pneumothorax (underlying lung disease) - COPD, asthma, pneumonia, malignancy, TB, CF, ARDS
3. Iatrogenic pneumothorax - CVL placement, barotrauma
4. Traumatic pneumothorax
5. Myocardial ischemia, pulmonary embolism, esophagitis

Question 4

What is the management of pneumothorax?

Answer 4

1. Observation may be appropriate for a small, asymptomatic pneumothorax
2. Treat immediately if hemodynamically unstable:
   - oxygen
   - support hemodynamics
   - needle aspiration (2nd or 3rd intercostal space, midclavicular line)
   - chest tube

Question 5

Where should needle aspiration be done for treatment of pneumothorax?

Answer 5

The needle should be inserted in the 2nd or 3rd intercostal space at the midclavicular line.