Pneumothorax

Question 1

What are signs and symptoms of pneumothorax?

Answer 1

• Dyspnoea
  
  • Pleuritic chest pain radiating to back
  • Reduced air entry/chest expansion
  • Hyper-resonance to percussion
  • Reduces vocal resonance
  • In tension, tracheal deviation to contralateral side
  • Circulatory collapse

Question 2

What is a tension pneumothorax?

Answer 2

When air in the pleural cavity is drawn in with each inspiration and cannot escape.

Question 3

What is management of pneumothorax?

Answer 3

For primary: if <2cm and no Sx, discharge and review.

If <2cm or Sx, aspirate. If no success, then drain.

For secondary: if >2cm or Sx, chest drain.

If 1-2cm, aspirate.

If <1cm, admit and give O2 for 24 hours.

Question 4

Where should chest drains be placed?

Answer 4

In the “triangle of safety”:
Bordered anteriorly by the lateral edge of pectoralis major, laterally by the lateral edge of latissimus dorsi, inferiorly by the line of the fifth intercostal space and superiorly by the base of the axilla

US guidance

Question 5

What is management of tension pneumothorax?

Answer 5

Aspiration or drain before CXR.
Immediate management is indicated with needle thoracostomy in the 2nd intercostal space mid-clavicular line.
A chest drain should be inserted into the affected side for ongoing management post return of spontaneous circulation.

Question 6

What are risk factors for a pneumothorax?

Answer 6

Primary spontaneous: being tall skinny man, Marfan,

Secondary spontaneous: COPD, asthma, CF, smoking, PJ pneumonia

Iatrogenic: mechanical ventilation, thoracentesis, central line insertion

Question 7

DDx for pneumothorax?

Answer 7

PE
MSK pain
Pleurisy
Pneumonia

Question 8

What Ix in pneumothoraxx?

Answer 8

CXR: see if trachea is central

US

Bloods; clotting before chest drain put in. Also rule out other causes e.g. infection, d dimer

ABG