Pneumothorax

Question 1

describe the treatment of primary and secondary pneumothorax.

Answer 1

primary

• no SOB then discharge
• SOB and/or air space >2cm = aspirate
• if aspirate fails then insert chest drain

secondary

• if air space < 1cm = 02 and observe for 24 hours
• if air space 1-2cm = aspirate
• if air space > 2cm and > 50yrs old = chest drain

Question 2

describe the treatment of iatrogenic pneumothorax.

Answer 2

majority spontaneously resolve but if they don’t then aspirate
ventilated patients and some with COPD require chest drain

lower rate of recurrence than spontaneous

Question 3

what are relative contraindications for a chest drain?

Answer 3

INR > 1.3
platelet count < 75 (normal 150-400)
pulmonary bullae
pleural adhesions

Question 4

what are complications of a chest drain?

Answer 4

failure to insert 
penetration of the lung 
bleeding 
infections 
re-ecpansion pulmonary oedema

Question 5

when should you remove a chest drain in a patient who had a pneumothorax?

Answer 5

when imaging shows pneumothorax has resolved

no longer bubbling spontaneously or when patient coughs

Question 6

how do you prevent re-expansion pulmonary oedema?

Answer 6

regular clamping of the drain tubing when there is rapid drain output

should exceed > 1l in < 6 hours