Pneumothorax

Question 1

Pneumothorax causes

Answer 1

Often spontaneous rupture of sub-pleural bulla in young thin man
Trauma
Chronic lung disease
Iatrogenic

Question 2

Pneumothorax presentation

Answer 2

Sudden onset dyspnoea +/ pleuritic chest pain
Reduced expansion
Hyper resonance to percussion
Diminished breath sounds on affected side
Trachea deviated away from affected side with tension pneumothorax

Question 3

Pneumothorax management priniciples

Answer 3

Depends on whether 1˚ or 2˚ (underlying lung disease/ smoker >50yrs old)
Size measured from visible lung margin to chest wall at level of hilum on CXR
If due to trauma/ mechanical vent, needs chest drain

Question 4

What is a tension pneumothorax

Answer 4

Pleural cavity pressure > atmospheric pressure

Question 5

Tension pneumothorax management

Answer 5

Don’t wait for CXR
14-16G needle with syringe partially filled with 0.9% saline into 2nd intercostal space in midclavicular line on side of pneumothorax and draw out air until chest tube can be placed

Question 6

When surgical consult needed for pneumothorax

Answer 6

Bilateral
2+ previous on same side
History of pneumothorax on opposite side

Lung fails to expand within 48h of intercostal drain insertion

Persistent air leak

Question 7

1˚ Pneumothorax management

Answer 7

Discharge and outpt review in 2-4 weeks if no SOB and <2cm of air on CXR
Aspirate if SOB/ >2cm rim of air on CXR
If aspiration unsuccessful chest drain in

Question 8

2˚ Pneumothorax management

Answer 8

If <1cm rim of air on CXR, admit for 24h, O2 and observe
If 1-2cm air rim on CXR aspirate then observe for 24h with O2
If SOB/ >2cm air rim on CXR; or if aspiration unsuccessful then chest drain