Pneumothorax

This image displays a large left sided haemothorax with mediastinal displacement to the opposite side. Clinically the patient would be in respiratory distress - percussion of the left side of the chest would be dull and breath sounds and vocal resonance would be reduced. A Haemothorax such as this falls into the category of life threatening chest injuries (ATOMFC) and requires emergent treatment using a chest drain in the 5th intercostal space, mid-axillary line and treatment according to ALS or ATLS protocols. ATOMFC = A = airway obstruction, T = tension pneumothorax, O = open pneumothorax, M = massive haemothorax, F = flail chest, C = cardiac tamponade.  

In this Chest X-Ray we can identify a left sided pneumothorax - there is absence of lung markings in the periphery and we can also see a shadow which outlines the edge of the lung. A pneumothorax is caused when air enters the potential space between the viceral and parietal pleura and causes the lung to collapse down under the pressure of it's elsatic recoil. In this case it is likely that the pneumothorax has been caused by trauma as we can see air in the soft tissues on the left side (surgical emphysema - clinically feels like bubble wrap). A pneumothorax can be a life threatening condition. The patient presents in respiratory distress with decreased expansion on the affected side. There will be hyperresonance to percussion on that side but absent breath sounds. The emergency treatment is decompression with a large bore cannula in the 2nd intercostal space mid-clavicular line followed by insertion a chest drain in the 5th intercostal space mid-axilllary line  

Early detection of a pneumothorax may be important in the clinical management of a trauma patient. Supine chest radiographs in the immobilized trauma patient have been shown to be insensitive.  

Define the various types of pneumothoraces. Describe the indications for needle aspiration and small-bore catheter placement in the management of pneumothoraces as outlined by the ACCP and BTS. Discuss the controversies surrounding needle aspiration and small-bore catheter placement for management of pneumothoraces. Identify the characteristics of those patients with pneumothoraces unlikely to be successfully treated with needle aspiration and small-bore catheter placement. Identify sub-sets of patients who have had their pneumothoraces successfully treated with needle aspiration and small-bore catheter placement.  

This video podcast outlines primary, secondary and tension pneumothorax. It continues to outline the relevant management of each type of pneumothorax.  

This video - produced by students at Oxford University Medical School in conjunction with the faculty - demonstrates how to perform the initial assessment of a patient with suspected traumatic injury.<br>This video is part 2 of a muti-system injury scenario (airway compromise, tension pneumothorax, bleeding and head injury).  

This video - produced by students at Oxford University Medical School in conjunction with the faculty - demonstrates how to perform the initial assessment of a patient with suspected traumatic injury.<br>This video is part 1 of a muti-system injury scenario (airway compromise, tension pneumothorax, bleeding and head injury).  

This is a teaching resource that aids the student in memorisation of tackling emergency pneumothrax  

A pneumothorax is a collection of air in the pleural space. They can be: Primary – no underlying lung disease. Typically, tall thin young men might have a spontaneous pneumothorax Secondary – to underlying lung disease   They can be divided into: Standard pneumothorax  

Fracture of the clavicle: Can occur after a fall on an outstretched arm (more likely to cause a Colles’ fracture in the old). Collar and cuff sling for 3 weeks, internal fixation only if there is non-union. Beware neurovascular injury and pneumothorax.    

A review of how to diagnose a pneumothorax, various forms of pleural effusion, other forms of pleural disease, and pneumoperitoneum. A differential diagnosis...  

Primary spontaneous pneumothorax is associated with smoking but defined as occurring in the absence of known lung disease  

http://usmlefasttrack.com/?p=6076 Pneumothorax, -, Spontaneous, &, Tension, Findings, symptoms, findings, causes, mnemonics, review, what is, video, study, R...  

http://usmlefasttrack.com/?p=6061 percussion, fremitus, tracheal deviation, pleural effusion, atelectasis, spontaneous pneumothorax, tension pneumothorax, co...  

It’s a typical busy Saturday night in your ED. The next chart you pick up is a 15-year-old male with cough shortness of breath and chest pain for one day. He is tall, with normal vitals and in no distress, and you note decreased breath sounds on his right side. Chest X-ray confirms it: pneumothorax.  

The chest x-rays show a thick walled cavity in the right middle lobe and an airspace opacity in the left upper lobe with cavity. There is a patchy opacity in the left lingular lobe. There is no pneumothorax or pleural effusion and the cardiomediastinal contour appears normal.  

In patients with occult traumatic pneumothoraces (OPTX) requiring positive pressure ventilation, is observation an acceptable alternative to tube thoracostomy?  

The chest x-rays show  pneumomediastinum. The expiratory chest x-ray also shows a continuous diaphragm sign due to the mediastinal air. There is peri bronchial thickening. There is no pneumothorax or air space consolidation.  

The supine chest x-ray shows a deep sulcus sign on the left, which is a radiological sign seen in supine patients with pneumothorax.