Pneumothorax (main)
Revision as of 18:12, 4 December 2014 by Rossdonaldson1 (talk | contribs)
Types
Tension pneumothorax
- Death occurs from hypoxic respiratory arrest (V-Q mismatch), not circulatory arrest
Diagnosis
- Diminished or absent breath sounds
- Hypotension or e/o hypoperfusion
- Distended neck veins
- May not occur if pt is hypovolemic
- Tracheal deviation
- Late sign
Treatment
- Immediate needle decompression if unstable
- 14ga IV in midclavicular line just above the rib at the second intercostal space
- Always followed by Chest Tube placement
Traumatic pneumothorax
Background
- Present in 25% of pts w/ chest trauma
- Rib fx and penetrating trauma most common causes
- Isolated ptx does not cause severe symptoms until >40% of hemithorax is occupied
Types
- Can be open, closed, or occult
- Open
- Communication between pleural space and atmospheric pressure (sucking chest wound)
- Occult
- PPV can convert an occult ptx to a tension ptx
- Open
Diagnosis
- Ptx after a stab wound may be delayed for up to 6 hr
- If pt decompensates obtain repeat imaging
- 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
- Upright is best (esp expiratory film)
- US
- Absence of lung sliding; absence of seashore (M-mode)
Treatment
- Tension ptx
- Immediate needle thoracostomy
- Open ptx
- Cover wound with three-sided dressing
- Make sure to avoid complete occlusion (may convert injury to a tension ptx)
- Cover wound with three-sided dressing
- 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
Special Instructions
Flying
- Can consider flying 2 weeks after full resolution of traumatic pneumothroax[1]
See Also
Source
- Roberts and Hedges Clinical Procedures in Emergency Medicine
- Rosen's
- American College of Chest Physicians Consensus Statement
- ↑ Cite error: Invalid
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