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Pneumothorax

From Mediwikis

This is vital to watch out for, especially those with sudden onset dyspnoea. Pneumothorax means the presence of air in the pleural space. As the pressure in the pleural space is ordinarily negative compared to atmospheric pressure, this means the increased pressure will cause neighbouring lung tissue to collapse. These can form spontaneously in tall, thin people. Tension pneumothorax refers to a progressively expanding collection of air in the pleural space, via a one way valve where air can collect but not escape (usually caused either by trauma or artificial ventilation). This causes much more pressure than a simple pneumothorax. Tension pneumothoraxes can compress the heart, leading to shock.
Large, right sided pneumothorax

Symptoms:

May be none! Or:

  • Sudden onset dyspnoea,
  • Pleuritic chest pain,
  • Respiratory distress.

Signs:

  • On affected side:
    • ↓Chest Expansion
    • Hyper-resonance
    • Reduced breath sounds
  • Deviated trachea especially in tension (away from the affected side).
  • Tachycardia
  • shock and distended neck veins (for tension in particular.)

Investigations

If tension pneumothorax is suspected, don't do any, you'll be wasting time - this is a life threatening emergency.

Otherwise, use chest X-ray to determine the extent and progression of the pneumothorax - one covering 15% or less of the hemithorax can be managed conservatively by observation but should be monitored to ensure it doesn't expand. It is visible by an area of blackness without normal lung markings, and the presence of the white line for visceral pleura away from the chest wall.

Management

If tension pneumothorax, insert wide-bore needle into 2IC mid-clavicular line. This converts it to a simple pneumothorax (and even if they had no sort of pneumothorax before, because you have pierced the pleural space they certainly have one now!).

Large simple pneumothoraxes are treated by placing a chest drain with a water seal.