Pneumothorax

Question 1

What is the definition of a pneumothorax?

Answer 1

Air leak between in the pleural space

Question 2

What are the types of pneumothorax?

Answer 2

Primary
Secondary
Traumatic
Tension

Question 3

Describe the types of pneumothorax?

Answer 3

Primary spontaneous
no underlying disease

Secondary spontaneous 
underlying lung disease 
Greater morbidity and mortality 
Greater symptom presence 
Not usually with exertion 

Traumatic
result of trauma
Iatrogenic (biopsies, aspiration)

Tension
Intrapleural space&raquo_space;> atmospheric pressure
Ball valve mechanism- pressure doesn’t escape

Question 4

What is the incidence of pneumothorax?

Answer 4

1-18/ 10000

Question 5

What are the RFs for pneumothorax?

Answer 5

Male > Females
BMI- tall skinny 
Smoking tobacco or cannabis
Older, over 55 
FHx
Recent medical procedures 

Resp. Conditions:
asthma 
COPD
TB
ILDs- cystic lung diseases
CF

Question 6

What are the signs and symptoms of pneumothorax?

Answer 6

Chest pain, sudden onset
Dyspnoea
Hyperexpanded, hyperresonant, ipsilateral hemithorax
Ipsilateral diminished breath sounds

SHx- pilot or diver, smoking, drugs
FHx
Review- wheezy, fevers, green sputum for infection

Question 7

What investigations fo you do for pneumothorax?

Answer 7

Bloods (should all be normal)
CXR (pneumothorax)
CT (for complex cases- bullous disease)
US chest but why

Question 8

What is the management and advice for a pneumothorax?

Answer 8

Large = =>2cm (50%) of lung margin and chest wall at level of hills

Treat underlying cause-Antibiotics/ injury management etc.
Nothing - watch and wait
Aspirate BEFORE DRAIN
Chest drain (<14Fr) (14-16G if tension pneumothorax)
Oxygen
Surgery

No flying 1-6 weeks after
No diving ever
Smoking cessation
Come back in if symptoms

Question 9

How do you relieve the different sizes of pneumothorax?

Answer 9

Primary:
Large (>2cm)- Aspirate with cannula
Small (<2cm)- discharge and review

Secondary:
Large (>2cm)- Chest drain (try aspiratiob first)
Small (<2 cm)- Aspirate with 16-18G cannula
V small (<1cm) watch and wait on admission (24hrs)

Question 10

What are the complications of a pneumothorax?

Answer 10

> Re-expansion pulmonary oedema

> Tal pleurodesis related ARDS

Question 11

What is the prognosis of a pneumothorax?

Answer 11

High rate of recurrence