pneumothorax

• What is a pneumothorax?

  Air enters the pleural space
• What does SLIT stand for in pneumothorax causes?

  Spontaneous, Lung pathologies, Iatrogenic, Trauma
• What characterizes primary pneumothorax?

  No previous lung disease, tall young male
• What are common symptoms of primary pneumothorax?

  Dyspnoea
• What defines secondary pneumothorax?

  Due to underlying lung diseases
• What lung diseases can cause secondary pneumothorax?

  Asthma or COPD
• What is a tension pneumothorax?

  Occurs after an incident
• What incidents can lead to a tension pneumothorax?

  Car incidents, stabbing, interventional radiology
• What are the features of a pneumothorax?

  Acute respiratory distress, tachypnoea, desaturation
• What is a sign of raised JVP in pneumothorax?

  Hypotension
• What percussion finding is associated with pneumothorax?

  Hyperresonance on percussion
• What does reduced air entry indicate in pneumothorax?

  No breathing sounds
• What is a symptom of pleuritic chest pain in pneumothorax?

  Sharp pain during breathing
• What is a key feature of tension pneumothorax?

  Tracheal deviation away from pneumothorax
• What is the acute onset symptom of tension pneumothorax?

  Dyspnoea
• What investigations are appropriate for a pneumothorax?

  CXR and CT thorax
• What does a CXR show in pneumothorax?

  No lung markings
• When is CT thorax used in pneumothorax?

  For very small pneumothorax
• What is the management for a primary spontaneous pneumothorax?

  • No significant symptoms and <2cm: conservative management (+/- supplementary oxygen)
  • Significant symptoms + ≥2cm: aspirate with needle
• What is the management for a secondary spontaneous pneumothorax?

  • <2cm: CT chest & reassess
  • ≥2cm: chest drain
• What is the management for a tension spontaneous pneumothorax?

  1. Needle decompression initially
  2. Chest drain (definitive management)
• What is the best management for persistent or recurrent pneumothorax?

  Video assisted thoracoscopic surgery (VATS)
• What must be done after conservative management is given?

  Follow up after 2-4 weeks
• If needle aspiration fails, what must be done?

  Chest drain + follow up after 2-4 weeks
• What is the management if a patient is severely distressed with a certain clinical diagnosis?

  High oxygen initially, needle decompression, chest drain
• What is the management if a patient is stable with good O2 saturation?

  Investigate with CXR to confirm diagnosis
• Where is needle decompression inserted?

  insert a large bore cannula into 5th ICS in the mid axillary line
• Where are chest drains inserted?

  5th ICS in the mid axillary line
• What is an alternative site for needle decompression insertion?

  2nd ICS at the midclavicular line
• Where should the chest drain be inserted relative to the mid-axillary line?

  Slightly anterior to mid-axillary line