Pneumothorax

Everything you need to know about this important medical emergency - covered in just 10 minutes (with example radiographs).

Video Duration: 10 minutes

  • Pneumothorax
    Created by Kate Bull
    General
    Epidemiology

    Definition: Air in the Pleural Cavity

    Primary: Occurs WITHOUT underlying pathology

    Secondary: Occurs WITH underlying pathology

    Tension: Usually following trauma

    Pathology

    Tension pneumothorax: a section of tissue acts as a one way valve allowing air to be drawn into the pleural cavity but not to escape.

    Top three causes

    Primary:

    1. Tall
    2. Smokers
    3. Connective Tissue Disorders

    Secondary:

    Biggest Cause: COPD

    Other Causes: TB, Sarcoid, Malignancy, Trauma, CF, Non-Invasive Ventilation

    Clinical Features
    Symptoms

    Primary + Secondary

    • Pleuritic chest pain
    • Shortness of Breath

    Tension

    • Signs of Trauma
    • Distress
    • Shortness of Breath
    Signs

    Primary + Secondary

    • Reduced chest expansion
    • Hyper-resonance
    • Reduced breath sounds
    Tension
    • Tracheal deviation
    • Tachycardia
    • Hypotension
    Investigations
    Cultures

    None

    Bloods

    ABG: measure of how well the patient is coping in primary and secondary

    Imaging

    Primary + Secondary: CXR

    Scopic/Biopsy

    None

    Functional

    None

    Treatment
    Conservative

    Primary - discharge with no treatment if:

    • No shortness of breath
    • Air space on CXR < 2 cm



    Medical

    Primary - needle aspiration if:

    • Short of breath
    • Air space on CXR > 2cm

    If unsuccessful - repeat needle aspiration

    If 2nd needle aspiration unsuccessful - chest drain

    Secondary - needle aspiration if:

    • No shortness of breath
    • Air space on CXR <2cm
    • Age < 50 years

    If unsuccessful - chest drain

    Secondary - chest drain as initial management if:

    • Shortness of breath
    • Air space on CXR >2cm
    • Age > 50 years
    Tension Pneumothorax - needle thoracostomy
    Surgical

    If symptoms do not resolve with the use of a chest drain - refer to chest physician