Pneumothorax: SIM case

Question 1

Define a primary spontaneous pneumothorax

Answer 1

A pneumothorax which presents without a precipitating external event in the absence of clinical lung disease.

Question 2

Epidemiology & risk factors:

• which gender is at greater risk?
• ______ increases risk

Answer 2

Men»women

SMOKING= risk increases with increasing smoking
-regular marijuana smoking

Question 3

Describe someone who is AT RISK for a spontaneous pneumo

i.e. weight, height..

Answer 3

**tall thin males especially between ages 10-30

Question 4

Primary spontaneous pneumothorax: Pathophysiology–> Small _______ blebs or bullae rupture into the _______

Answer 4

• subpleural

- pleural cavity

Question 5

Primary spontaneous pneumothorax:

-describe the presentation?

Answer 5

Sudden onset of dyspnea & pleuritic chest pain, usually unilateral. May have diminished or absent breath sounds on the affected side, absent tactile or vocal fremitus, and hyperresonant percussion

Question 6

Primary spontaneous pneumothorax:

-check for tracheal deviation away from the _______ side

Answer 6

affected

Question 7

Primary spontaneous pneumothorax:

Dx? (what imaging study)

Answer 7

Upright chest xray shows a white visceral pleural line without bronchovascular markings seen beyond the pleural line.

Question 8

Primary Spontaneous:

-Management: Are they stable? Must meet all criteria:

Answer 8

RR <24, HR >60 and <120, BP normal, O2 sats >90% on RA, able to speak in full sentences). If stable, management depends on the size

Question 9

Small Spontaneous pneumo= ≤ __ cm

Answer 9

small= ≤3 cm at apex or ≤2 cm at hilum

Question 10

To meet the definition of a small pneumothorax, the first episode of PSP you must observe _______

Answer 10

first episode of PSP: Observe (can give oxygen- research shows the air is resorbed faster from the pleural space if humidified 100% oxygen is administered) and can discharge

Question 11

Define a large spontaneous pneumo:

Answer 11

Large (>3 cm at apex or >2 cm at hilum)

Question 12

Management for a large pneumo thorax

Answer 12

Usually aspiration or chest or cathether thoracostomy

Question 13

If the Pt is unstable, what do you do?

Answer 13

Immediate chest tube thoracostomy or needle decompression if you can’t complete the chest tube immediately.

Question 14

Does the Patient have all the following?

list the criteria for determining if a Pt is stable

Answer 14

• RR <24 BPM
• HR <120 and >60 BPM
• Normal BP
• Room air O2 sat >90%
• speaking in whole sentences

Question 15

If Pt DOES NOT meet the initial criteria: (unstable)

- what steps are next?

Answer 15

-IMMEDIATE drainage with chest tube/catheter thoracostomy (alternatively, needle thoracostomy if tube/catheter thoracostomy is delayed)