Pneumothorax
Summary
Symptoms
Investigations
Management
*Do not do CXR first if suspected tension pneumothorax
Conservative
Symptoms
- Asymptomatic
- Pleuritic chest pain
- Sudden deterioration
- Tall, thin, young (20s), male
- Smoker
- Lung disease (COPD)
- PAP
- Tracheal tug (away from affected side)
- Diminished expansion
- Hyper-resonant
- Reduced breath sounds
Investigations
- Bloods: ABG
- Imaging: expiratory CXR
Management
*Do not do CXR first if suspected tension pneumothorax
Conservative
- O2
- NSAIDs
- Aspiration (syringe)
- Then CXR
- Chest drain (chest tube)
- Pleurodesis (recurrent)
Definition
Primary - No identifiable lung disease
Secondary - Caused by lung pathology (most common COPD)Tension pneumothorax = mediastinum compression --> ↓HR ↓BP
Risk Factors
Aetiology
Spontaneous - Primary or secondary
Non - spontaneous - Trauma, iatrogenic (bronchoscopy, jugular line)
Clinical Features
Symptoms
Signs
Investigations
Imaging:
Treatment
Conservative
Non-conservative (only if gas exchange bad)
Source
Dr Greg Haug 2014
OHCM 9th Ed 2014
- Air between visceral and parietal pleura
Primary - No identifiable lung disease
Secondary - Caused by lung pathology (most common COPD)Tension pneumothorax = mediastinum compression --> ↓HR ↓BP
Risk Factors
- Tall
- Thin
- Male
- Smoker
- Large barometric changes
Aetiology
Spontaneous - Primary or secondary
Non - spontaneous - Trauma, iatrogenic (bronchoscopy, jugular line)
- Apical bleb (vesicle) --> rupture = pneumothorax
Clinical Features
Symptoms
- Pleuritic chest pain (due chemical pain response)
- Dyspnoea (due V/Q mismatch - only some)
Signs
- ↓ Expansion
- Resonant (with ↓ expansion)
- No breath sounds
Investigations
Imaging:
- Expiratory film X ray (every pneumothorax looks bigger on expiration)
Treatment
Conservative
- O2
- NSAIDs
Non-conservative (only if gas exchange bad)
- Aspiration (14-16G syringe into midclavicular 2nd intercostal space)
- Chest drain (chest tube)
- Pleurodesis (recurrent)
Source
Dr Greg Haug 2014
OHCM 9th Ed 2014