Pneumothorax Flashcards
Pneumothorax?
Tension Pneumothorax?
P: Air in the pleural space leading to lung deflation.
TP: Air drawn in has no route to escape for expiration, mediastinum pushed over to contralateral side –
Ix for Pneumothorax?
Ix for Tension Pneumothorax?
Otherwise, request CXR: look for an area without lung markings peripheral to the edge of the collapsed lung
A CXR should not be requested if a tension pneumothorax is suspected, as it will delay necessary treatment.
Tx of Tension Pneumothorax ?
Aspiration before requesting CXR - then insert chest drain
Tx of Pneumothorax:
differs depending on whether it is primary or secondary (due to underlying lung disease or smoker >50)
if it is primary:
- what do you do if they do/don’t have SOB and/or rim of >2cm on CXR?
- if aspiration is successful?
if it is secondary:
- what do you do if they do/don’t have SOB and/or rim of >2cm on CXR?
primary
- if they have a rim >2cm and/or SOB - do aspiration –> if aspiration successful –> chest drain
if unsuccessful aspiration –> discharge and r/v in 2-4 wks
if they dont have a rim >2cm and/or SOB –> discharge + r/v in 2-4 wks.
secondary
- f they have a rim >2cm and/or SOB ->chest drain
- if between 1-2cm - do aspiration –> successful (chest drain), unsuccessful (24h observation + oxygen)
if <1cm rim = 24h observation + oxygen
A 29-year-old man is admitted with sudden onset dyspnoea and pleuritic chest pain. He is a smoker but has no history of respiratory disease. He considers himself healthy and regularly plays rugby. On admission he has a chest x-ray that shows a pneumothorax with a 3cm rim of air. Aspiration is successful and he is discharged. A follow-up chest x-ray two weeks later shows a complete resolution. What is the single most important piece of advice to reduce his risk of further pneumothoraces?
stop smoking avoid flying for 12 months avoid contact sports for 12 months arrange physiotherapy seek medical advice for resp infections
stop smoking
All patients should be advised to avoid smoking to reduce the risk of further episodes - the lifetime risk of developing a pneumothorax in healthy smoking men is around 10% compared with around 0.1% in non-smoking men
A 24-year-old male with no past medical history presents to the Emergency Department with pleuritic chest pain. There is no history of a productive cough and he is not short of breath. Chest x-ray shows a right-sided pneumothorax with a 1 cm rim of air and no mediastinal shift. What is the most appropriate management?
immediate 14G cannula into 2nd intercostal space
discharge with outpatient CXR
aspiration
intercostal drain insertion
admit for 48hrs observation
discharge with outpatient CXR
A 27-year-old man with no significant past medical history of note presents to the Emergency Department with a one day history of dyspnoea and right-sided pleuritic chest pain. A chest x-ray is taken which shows a right pneumothorax with a 2.5cm rim of air and no mediastinal shift. Aspiration is performed by the admitting doctor.
He is reviewed four hours later. His dyspnoea has resolved but the chest x-ray shows that whilst the pneumothorax has improved there is still a 1cm rim of air. What is the most appropriate management?
repeat aspiration
intercostal drain insertion
admit for observation
discharge with outpatient CXR
discharge with outpatient CXR
The British Thoracic Society algorithm for spontaenous pneumothorax suggests that if following aspiration the rim of air is < 2cm and the breathing has improved then discharge should be considered with outpatient review.
A 60-year-old female with a history of COPD presents to the Emergency Department with shortness of breath. Blood pressure is 120/80 mmHg and he pulse is 90 bpm. The chest x-ray shows a pneumothorax with a 2.5 cm rim of air and no mediastinal shift. What is the most appropriate management?
intercostal drain insertion discharge admit for 48h observation aspiration 14G cannula into 2nd intercostal space, mid clavicular line
intercostal drain insertion
