Pneumothorax

Question 1

What are the symptoms of pneumothorax?

Answer 1

Sudden onset pleuritic chest pain
Breathlessness
Tachycardia
Tachypnoea

Question 2

What are some causes of pneumothorax?

Answer 2

Spontaneous- esp in young thing men
Chronic lung disease- COPD, Asthma, CF, Fibrosis, Sarcoidosis
Infection- TB, Pneumonia, Lung Abscess
Traumatic
Connective Tissue Disorders- Marfan, Ehlers Danlos

Question 3

What are the examination findings of a pneumothorax?

Answer 3

Hyperresonance on percussion
Reduced breath sounds
Reduced expansion

If tension- deviated trachea and this requires urgent decompression

Question 4

How should you investigate for a pneumothorax?

Answer 4

Note if there is any deviation of the trachea or haemodynamic instability DO NOT DO A CXR THIS IS A TENSION PNEUMOTHORAX WHICH IS A MEDICAL EMERGENCY- URGENT DECOMPRESSION

Otherwise do a CXR
Oxygen saturations
Do an ABG if hypoxic

Question 5

What are some signs of a tension pneumothorax?

Answer 5

Tracheal deviation
Raised JVP
Hypotension
Tachycardia
Tachypnoea

Occurs due to air being progressively drawn into pleural space and compressing the veins and so reduced venous return to the heart.

Question 6

What is the management for a tension pneumothorax?

Answer 6

Needle Aspiration- 2nd ICS MCL (on the affected side)

A small amount of 0.9% saline is placed in the syringe and the plunger drawn fully out when aspirating. The saline acts live a seal and lets air bubble out. A chest drain should then be placed (5 ICS MAL)

Or use a large bore cannula

Question 7

What is the management for a primary pneumothorax?

Answer 7

CXR done and management depends on whether the rim of air is greater than 2cm or not.

If greater than 2 cm- Chest drain 5th ICS MAL

If less than 2 cm and not short of breath- consider discharge

Question 8

What should you advise any patient with a primary pneumothorax?

Answer 8

Stop smoking

Smoking increases the lifetime risk by 100x

Question 9

What is the management for a secondary pneumothorax?

Answer 9

Depends upon if the patient is aged 50 or over.

If aged 50 or over:
- Rim of air is > 2 cm and/or SOB
=> Chest drain 5th ICS MAL

If not SOB or rim of air 1-2cm
=> Needle aspiration and if not successful insert a chest drain 5th ICS MAL, if successful admit and monitor for 24 hours

If not SOB and rim less than 1 cm
=> Admit for 24 hours and monitor

Question 10

When should surgical advice be sought for pneumothorax?

Answer 10

If bilateral
Lung fails to expands within 48 hours of drain
Persistent air leak
Two or more previous pneumothoraces on the same side
History of pneumothorax on the opposite side

Question 11

What are the boundaries of the safe triangle?

Answer 11

Lateral border of pectoralis major
Anterior border of latissimus dorsi
Base of axilla
5th ICS