PTX

Question 1

what is a pneumothorax

Answer 1

when air gains entry into and accumulates in the pleural space

Question 2

what is the classification of PTX?

Answer 2

spontaneous

• primary = without pulmonary disease
• secondary = with pulmonary disease

traumatic

iatrogenic

tension

Question 3

what are the S&S of PTX?

Answer 3

dyspnoea
pleuritic chest pain
respiratory distress

reduced A/E on affected side
hyperresonance to percussion
tracheal deviation to contralateral side
decreased vocal resonance

Question 4

what investigations are done in PTX?

Answer 4

CXR

• visible rim between lung margin and chest wall
• absence of lung marking between lung margin and chest wall

Bloods
- typically normal

CT chest

• presence of visible visceral pleural line
• actelectasis or hyperexpansion of ipsilateral hemithorax

Question 5

what is the treatment of tension pneumothorax?

Answer 5

medical emergency

immediate decompression - 2nd ICS, mid clavicular line

high flow 02

chest drain after decompression

Question 6

what is the treatment of primary spontaneous PTX

Answer 6

<2cm can consider discharge

> 2cm

• aspiration - 16-18G catheter, 2nd ICS Mid clav
• if not worked then chest drain

chest drain
- triangle of safety = nipple, lateral border of pec major, anterior border of lattisimus dorsi

o2

pain relief

Question 7

what surgical options are availble if chest drain fails?

Answer 7

VATS
Staple blebs
Talc pleurodiesis
Pleural abrasion/stripping

Question 8

what are the complications of PTX?

Answer 8

re-expansion pulmonary oedema

talc-pleurodiesis related ARDS

Question 9

what are the treatment options for secondary spontaneous PTX?

Answer 9

<1cm
- High flow 02

1-2cm

• aspirate
• chest drain if fail

> 2cm
- chest drain