Respiratory: pneumothorax

Question 1

If spontaneous pneumothorax is symptomatic, what is the next step? (BTS)

Answer 1

Assessment for high-risk characteristics:
* haemodynamic compromise (suggesting a tension pneumothorax)
* significant hypoxia
* bilateral pneumothorax
* underlying lung disease
* ≥ 50 years of age with significant smoking history
* haemothorax

Question 2

if no high risk characteristics are present with a symptomatic spontaneous what are the choices of intervention?

Answer 2

• conservative care
• ambulatory device
• needle aspiration

Question 3

if any high risk characteristics are present with a symptomatic spontaneous what is the intervention?

Answer 3

chest drain

Question 4

When is it safe to intervene in a spontaneous pneumothorax?

Answer 4

• before a needle aspiration/chest drain insertion, the safety of intervention should be assessed
  this depends on the clinical context, but is usually:
• > =2cm laterally or apically on chest x-ray, or
• any size on CT scan which can be safely accessed with radiological support

Question 5

If the patient with a spontaneous pneumothorax is asymptomatic , what should be done?

Answer 5

conservative care, regardless of pneumothorax size
* if it is a primary spontaneous pneumothorax, pt reviewed every 2-4 days as OP
* if secondary spontaneous pneumothorax - monitored as IP
* if stable FU in OP in 2-4 weeks