Pneumothorax

Question 1

What are the features of a pneumothorax?

Answer 1

SOB
sudden pleuritic chest pain
Sweating
tachycardia
tachypnoea

Question 2

What are the causes of a pneumothorax?

Answer 2

spontaneous
trauma
due to mechanical ventilation or central line insertion
infection, asthma or COPD

Question 3

What are the investigations for a pneumothorax?

Answer 3

erect CXR (will see area between lung tissue and chest wall where there are no markings) (will allow you to measure the size)
CT thorax for very small ones

Question 4

What is the management of a pneumothorax?

Answer 4

Primary:
No SOB, <2cm = will spontaneously resolve
SOB/>2cm = aspiration and reassessment
If aspiration fails twice, a chest drain will be required

Secondary (pre existing lung disease)
If >50 and >2cm/SOB then put a chest drain in
otherwise, aspiration between 1-2cm

Question 5

What occurs in a tension pneumothorax?

Answer 5

A one way valve is created where air can go in, but not go out. Can lead to mediastinal shift or cardiopulmonary arrest

Question 6

What are the signs of a tension pneumothorax?

Answer 6

tracheal deviation away from the side of a pneumothorax
reduced air entry to affected side
increased resonance on affected side
tachycardia
hypotension

Question 7

What is the management of a tension pneumothorax?

Answer 7

insert a large bore cannula into the second intercostal space in the midclavicular line
(needle decompression then chest drain insertion)
chest drains should be inserted in the fifth intercostal space in the midaxillary line