Pneumothorax

Question 1

What is pneumothorax?

Answer 1

Accumulation of air in pleural space (between visceral and parietal pleura)

Question 2

What are the two types of pneumothorax?

Answer 2

1. Spontaneous
2. Traumatic

Question 3

Discuss spontaneous pneumothorax

Answer 3

Primary = occurs without trigger in otherwise normal lung

Secondary = occurs in lung with pre-existing lung disease e.g. COPD, asthma etc

Patients are typically tall, thin, young males

M:F 6:1

Usually apical

Question 4

Management of spontaneous pneumothorax

Answer 4

If small - no treatment needed

If moderate - admit for aspiration

Question 5

What is tension pneumothorax?

Answer 5

Injured pleura (stabbing, rib fracture) forms a one way valve that allows air into the pleura but not back out

Pneumothorax gets worse with every breath

If enough air builds up it can push on the trachea and cause it to deviate

Venous return in the heart is impaired which reduces systolic BP due to decreased stroke volume

Question 6

Why would USS be used to assess for pneumothorax instead of gold-standard CT?

Answer 6

In supine trauma patients USS is better for detecting pneumothorax

Question 7

Examination findings in pneumothorax

Answer 7

• Affected side moves less - palpate and compare sides
• Trachea deviated away from side of collapse
• Hyperreonance on percussion
• Breath sounds reduced or absent

Question 8

How is a tension pneumothorax managed?

Answer 8

Large bore needle into 2nd or 3rd anterior intercostal space - gush of air confirms diagnosis

Thoracostomy with underwater seal drainage

Question 9

Pneumothorax vs pleural effusion?

Answer 9

Pleural effusion occurs more slowly and is dull on percussion

Pneumothorax occurs rapidly and is hyperresonant on percussion