Pneumothorax Management Flashcards
What are the classifications of pneumothorax?
- Primary
- Secondary
- Tension
Primary pneumothorax typically affects tall, thin, young males, while secondary pneumothorax occurs in patients with pre-existing respiratory diseases.
Tension:
■ Penetrating or blunt trauma
■ Mechanical ventilation or NIV
■ Conversion from simple pneumothorax
What are the risk factors for pneumothorax?
- Smoking
- Recent trauma
- Family history
These factors can increase the likelihood of developing a pneumothorax.
What are the common symptoms of pneumothorax?
- Ipsilateral pleuritic chest pain
- Dyspnoea
- Cough
Symptoms may vary based on the type and severity of pneumothorax.
What are the differential diagnoses (DDx) for pneumothorax?
- Acute asthma exacerbation
- Pleural effusion
- Pulmonary embolism (PE)
- Myocardial infarction (MI)
These conditions may present with similar symptoms and require exclusion.
What are the signs of pneumothorax on physical examination?
- Hyper-resonance to percussion
- Reduced breath sounds
- Reduced chest expansion
These findings can help in the clinical assessment of pneumothorax.
What are the signs of tension pneumothorax?
- Tracheal deviation (away from pneumothorax)
- Severe tachycardia
- Hypotension (HoTN)
Tension pneumothorax is a life-threatening condition requiring immediate intervention.
What bedside investigations are used for pneumothorax?
- Pulse oximetry
- Lung ultrasound (US)
Lung ultrasound is particularly useful in supine trauma patients where a chest X-ray may not be feasible.
What blood tests are important in the management of pneumothorax?
- Full blood count (FBC)
- Coagulation profile
- Arterial blood gases (ABG)
Exclude DDx:
■ Troponin - outrule MI
■ WCC & CRP - outrule pneumonia
■ NT-proBNP - outrule chronic heart failure
FBC is crucial for assessing transfusion needs in trauma, while ABG can indicate respiratory alkalosis due to hyperventilation.
How is the size of a pneumothorax measured on a chest X-ray?
At the level of the hilum; >2 cm is considered a ‘large’ pneumothorax.
Accurate measurement is key for determining the management approach.
What is the first-line treatment for tension pneumothorax?
Emergency decompression with a large-bore cannula (14G or 16G) in the 2nd intercostal space, midclavicular line.
Chest drain insertion (in triangle of safety Immediately after emergency decompression
“triangle of safety” (lateral border of pec major, anterior border of lat dorsi, and nipple line) and “above the rib below”
What are the steps for treating a simple (non-tension) pneumothorax?
What complications can arise from pneumothorax?
- Respiratory failure
- Cardiac arrest (in tension)
- Pneumopericardium
These complications can be severe and require immediate medical attention.
