Respiratory 9 - Pneumothorax

Question 1

define pneumothorax

Answer 1

when air accumulates in the pleural space, separating the lung from the chest wall

Question 2

4 causes of pneumothorax

Answer 2

spontaneous (‘tall thin male playing sport’)
trauma
iatrogenic (procedure trauma)
lung pathology (infection, asthma, COPD)

Question 3

2 key investigations with pneumothorax

Answer 3

erect chest x ray (absence of lung markings in peripheral zone somewhere)

CT thorax for small ones + possible causes / sizing

Question 4

how do you measure a pneumothorax on a chest x ray (erect)?

Answer 4

measure horizontally from lung edge to in line with the hilum

Question 5

guidelines for managing pneumothorax

Answer 5

if <2cm rim of air, no treatment but follow up 1 month

if >2cm + symptoms, aspirate

if twice failed aspiration, need chest drain

unstable or bilateral need chest drain

Question 6

5 signs of tension pneumothorax

Answer 6

tracheal deviation away from the pneumothorax
increased resonance on pneumothorax side
tachycardia
hypotension

worsening

Question 7

classic line for management of tension pneumothorax

Answer 7

insert a large bore cannula into the second intercostal space in the midclavicular line

urgently!!! chest drain later

Question 8

define the triangle of safety for a chest drain

Answer 8

5th intercostal space (roughly in line with inferior aspect of nipple)
border of lat dorsi
border of pec major

Question 9

on which side of the rib do you insert a chest drain?

Answer 9

just above

the neurovascular bundle runs just below each rib