Pneumothorax Basics

Question 1

What is a pneumothorax?

Answer 1

Presence of air in the pleural space (the area between the lung and chest wall).

Question 2

What can a pneumothorax cause?

Answer 2

Cause partial or complete lung collapse. It disrupts the normal negative pressure within the pleural cavity, leading to lung deflation

Question 3

What is a severe type of pneumothorax?

Answer 3

Tension pneumothorax.

Question 4

What is tension pneumothorax?

Answer 4

Air is not able to leave the pleural cavity
During inspiration air is drawn in
During expiration air is trapped in pleural space

Question 5

What can happen with a tension pneumothorax?

Answer 5

More air can keep coming in
With inspiration can’t escape
Gets larger with each breath
Pressure increase in the thorax
Pushes the mediastinum
Kicks big vessels in the mediastinum
Cardiac arrest

Question 6

What causes pneumothorax?

Answer 6

Spontaneous

Secondary:
- trauma
- iatrogenic, medical intervention / lung biopsies
- lung pathology

Question 7

What are the symptoms of pneumothorax?

Answer 7

Sudden, sharp chest pain (usually on one side).
Shortness of breath.
Tachypnea (rapid breathing).
Tachycardia (rapid heart rate).
Decreased or absent breath sounds on the affected side.
Hypoxia (low oxygen levels).
Cyanosis (in tension pneumothorax).
Hypotension and shock (in severe tension pneumothorax).

Question 8

What is the diagnosis to pneumothorax?

Answer 8

Physical examination: Reduced or absent breath sounds on the affected side, hyperresonance to percussion, and reduced chest expansion.

Chest X-ray: Reveals a visible line indicating the edge of the collapsed lung and absence of lung markings beyond that line.

CT scan: More sensitive and useful for identifying small pneumothoraxes or in complex cases.

Ultrasound: Can be used in trauma settings to quickly detect pneumothorax, especially in emergency situations.

Question 9

What is the management for pneumothorax?

Answer 9

No SOB and less than 2cm in size on chest xray – no treatment required as randomly resolves – follow up 2-4 weeks with CXR to see if has resovles

SOB / more than 2 cm in size – aspiration and reassessment after

If aspiration fails twice – chest drain

Unstable / bilateral secondary – chest drain

Question 10

What is the management for tension pneumothorax?

Answer 10

“Inset a large bore cannula into the second intercostal space in the mid-clavicular line’

Creates a way for air to get out and pleural cavity, release tension lungs can re-expand and mediastinum and cardiac vessels can go back into place

Don’t wait for investigations with each breath pnemothroax gets bigger

Then put in chest drain as a definitive treatment to remove the air

Question 11

Where do you put a chest drain?

Answer 11

Inserted into triangle of safety – least likely to damage medical structures – 5th intercostal space or inferior nipple line / mid axillary line or lateral edge latissimus dorsai / anterior axillary line or lateral edge of pectrolis major