Traumatic pneumothorax: Difference between revisions

Revision as of 19:54, 13 May 2015

Open
- Communication between pleural space and atmospheric pressure (sucking chest wound)
Closed
Occult
- Positive pressure ventilation (e.g. intubation) can convert an occult pneumothorax to a tension pneumothorax

Rib fracture and penetrating trauma most common causes
Isolated pneumothorax does not cause severe symptoms until >40% of hemithorax is occupied

The pleural cavity is normally a potential space, in which air collects in a pneumothorax.

CXR
- Upright is best (esp expiratory film)
  - Thin white line (pleura) between 2 areas of lucency (lung parenchyma and air)
  - No lung markings distal to white line
- Supine
  - Look for deep sulcus sign
Ultrasound
- Absence of lung sliding; absence of seashore (M-mode)
CT chest
- Most sensitive
Ptx after a stab wound may be delayed for up to 6 hr
- If pt decompensates obtain repeat imaging

Cover wound with three-sided dressing
- Make sure to avoid complete occlusion (may convert injury to a tension pneumothorax)

Tube thoracostomy indicated if:
- Cannot be observed closely
- Requires intubation
- Will be transported by air or over a long distance
Observation alone if:
- Small AND does not require mechanical ventilation
  - Initial [[CXR]: <1cm wide (confined to upper 1/3 of chest) OR seen only on CT
  - Unchanged on repeat CXR in hours

Flying

Authors:

@@ Line 7: / Line 7: @@
 #Closed
 #Occult
-#*PPV can convert an occult ptx to a tension ptx
+#*Positive pressure ventilation (e.g. [[intubation]]) can convert an occult pneumothorax to a tension pneumothorax
 ==Clinical Features==
@@ Line 32: / Line 32: @@
 ==Treatment==
-*Tension ptx
+===[[Tension pneumothorax]]===
-**Immediate needle thoracostomy
+**Immediate [[needle thoracostomy]] followed by [[chest tube]]
-*Open ptx
-**Cover wound with three-sided dressing
-***Make sure to avoid complete occlusion (may convert injury to a tension ptx)
-*Tube thoracostomy indicated if:
-**Pt cannot be observed closely
-**Pt requires intubation
-**Pt will be transported by air or over a long distance
-*Observation alone ok if:
-**Small ptx (<1cm wide, confined to upper 1/3 of chest) is unchanged on two CXR 6hr apart
-**Occult ptx (seen only on CT) unless pt requires mechanical ventilation
+===Open pneumothorax===
+*Cover wound with three-sided dressing
+**Make sure to avoid complete occlusion (may convert injury to a tension pneumothorax)
+===Closed traumatic pneumothorax===
+*[[Tube thoracostomy]] indicated if:
+**Cannot be observed closely
+**Requires intubation
+**Will be transported by air or over a long distance
+*Observation alone if:
+**Small AND does not require mechanical ventilation
+***Initial [[CXR]: <1cm wide (confined to upper 1/3 of chest) OR seen only on CT
+***Unchanged on repeat [[CXR]] in hours
+==Disposition==
 ===Special Instructions===
 '''Flying'''