RRAPID: Pneumothorax (Tension)

Question 1

Features of pneumothorax? (5)

Answer 1

SOB (sudden onset)
Pleuritic chest pain
Unilateral reduced chest expansion
Unilateral decreased breath sounds
Unilateral hyp-resonance to percussion

Question 2

Specific features of a tension pneumothorax? (3)

Answer 2

Hypotension (most reliable sign)
Trachea deviated away from the affected side (late)
Distended neck veins

Question 3

Response (Airway)?

Answer 3

Give O2 15L/min via a reservoir mask

Question 4

Response (Breathing)?

Answer 4

CXR

Question 5

Response (Circulation)?

Answer 5

IV access

Bloods

Question 6

Mx of pneumothorax?

Answer 6

Needle compression: large bore needle (14-16G) 2nd intercostal space mid-clavicular line.

The needle should be left in place before insertion of chest tube.

Question 7

Where should the chest tube be inserted?

Answer 7

5th intercostal space mid-axillary line

Question 8

Mx of primary pneumothorax and size > 2cm and/or breathless

Answer 8

Needle compression/Aspirate: large bore needle (14-16G) 2nd intercostal space mid-clavicular line.

Question 9

Mx of secondary pneumothorax (evidence of underlying lung disease/age >50 and significant smoking Hx)?

Answer 9

Chest drain (5th intercostal space mid-axillary line)

Question 10

Mx of pneumothorax due to trauma?

Answer 10

Chest drain (5th intercostal space mid-axillary line)