[Resp] Pneumothorax

Question 1

what is PTX split into?

Answer 1

primary vs. secondary

Question 2

what is 1˚ PTX?

Answer 2

no underlying lung pathology

Question 3

what is 2˚ PTX?

Answer 3

lung disease e.g. COPD / asthma

Question 4

what does 1˚ PTX tend to be?

Answer 4

asymptomatic

can also present with:

• dyspnoea
• pleuritic chest pain

Question 5

what does 2˚ PTX tend to have?

Answer 5

breathlessness out of proportion to the size of PTX

Question 6

what should you do for PTX that is bilateral or pt is haemodynamically unstable?

Answer 6

proceed to chest drain

Question 7

for 1˚ PTX, how would you manage a PTX that is >2cm / pt is complaining of breathlessness?

Answer 7

needle aspiration

Question 8

for 1˚ PTX, what do you do if needle aspiration is successful (<2cm) and breathing is improved?

Answer 8

discharge + review in OPD

Question 9

for 1˚ PTX, what do you do if needle aspiration is unsuccessful and breathing is not improved?

Answer 9

chest drain + admit

Question 10

for 1˚ PTX, how would you manage a PTX that is <2cm / pt is not complaining of breathlessness?

Answer 10

discharge + review in OPD

Question 11

for 2˚ PTX, how would you manage a PTX that is >2cm / pt is complaining of breathlessness?

Answer 11

chest drain + admit

Question 12

for 2˚ PTX, how would you manage a PTX that is <2cm / pt is not complaining of breathlessness?

Answer 12

if PTX is 1-2cm → needle aspiration

if PTX is not 1-2cm → admit + observe for 24 h

Question 13

for 2˚ PTX, what do you do if needle aspiration is successful (<1cm) and breathing is improved?

Answer 13

admit + observe for 24 h

Question 14

for 2˚ PTX, what do you do if needle aspiration is unsuccessful and breathing is not improved?

Answer 14

chest drain + admit

Question 15

what is a tension PTX?

Answer 15

medical emergency – requires emergency decompression with grey cannula into 2nd ICS, MCL

Question 16

what happens in tension PTX?

Answer 16

one-way valve system
air in during inspiration, no air out during expiration
intrapleural pressure > atmospheric pressure → impaired venous return and reduced cardiac output

Question 17

what is tension PTX associated with?

Answer 17

• ventilated pts on ICU / pts on NIV
• trauma
• acute asthma / COPD presentations
• blocked, clamped or displaced chest drains

Question 18

what are the radiological features of tension PTX?

Answer 18

• airway pulled away from side of PTX
• mediastinal shift
• reduced lung markings

Question 19

what are the features of haemodynamic instability associated with tension PTX?

Answer 19

• hypoxia
• hypotension
• tachycardia

Question 20

increased lung compliance. dx?

Answer 20

emphysema

Question 21

FEV1/FVC ratio < 0.7 dx?

Answer 21

obstructive lung pathology

Question 22

T2RF with raised bicarbonate. dx?

Answer 22

chronic T2RF, aim sats 88-92%

Question 23

what is the 1st line ix for PTX?

Answer 23

CXR

Question 24

what is the mx of PTX dependent on?

Answer 24

type and size of PTX

Question 25

what do all 2˚ PTX need?

Answer 25

admission