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| ==Types== | | ==Types== |
| *[[Spontaneous pneumothorax]]
| | {{Pneumothorax types}} |
| [[File:Pneumothorax.jpeg|thumbnail]]
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| ==[[Tension pneumothorax]]==
| | [[File:Pneumothorax.png|thumbnail|Right sided pneumothorax]] |
| *Death occurs from hypoxic respiratory arrest (V-Q mismatch), not circulatory arrest
| | [[File:PMC2892654 CRM2010-213818.004.png|thumb|Left sided [[tension pneumothorax]] with mediastinal shift]] |
| ===Diagnosis===
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| *Diminished or absent breath sounds
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| *Hypotension or e/o hypoperfusion
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| *Distended neck veins
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| **May not occur if pt is hypovolemic
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| *Tracheal deviation
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| **Late sign
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| ===Treatment===
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| *Immediate needle decompression if unstable
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| **14ga IV in midclavicular line just above the rib at the second intercostal space
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| *Always followed by [[Chest Tube]] placement
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| ==[[Traumatic pneumothorax]]==
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| ===Background===
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| *Present in 25% of pts w/ chest trauma
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| *Rib fx and penetrating trauma most common causes
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| *Isolated ptx does not cause severe symptoms until >40% of hemithorax is occupied
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| ===Types===
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| *Can be open, closed, or occult
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| **Open
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| ***Communication between pleural space and atmospheric pressure (sucking chest wound)
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| **Occult
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| ***PPV can convert an occult ptx to a tension ptx
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| ===Diagnosis===
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| *Ptx after a stab wound may be delayed for up to 6 hr
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| **If pt decompensates obtain repeat imaging
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| *CXR
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| **Upright is best (esp expiratory film)
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| ***Thin white line (pleura) between 2 areas of lucency (lung parenchyma and air)
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| ***No lung markings distal to white line
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| **Supine
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| ***Look for deep sulcus sign
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| *US
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| **Absence of lung sliding; absence of seashore (M-mode)
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| ===Treatment===
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| *Tension ptx
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| **Immediate needle thoracostomy
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| *Open ptx
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| **Cover wound with three-sided dressing
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| ***Make sure to avoid complete occlusion (may convert injury to a tension ptx)
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| *Tube thoracostomy indicated if:
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| **Pt cannot be observed closely
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| **Pt requires intubation
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| **Pt will be transported by air or over a long distance
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| *Observation alone ok if:
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| **Small ptx (<1cm wide, confined to upper 1/3 of chest) is unchanged on two CXR 6hr apart
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| **Occult ptx (seen only on CT) unless pt requires mechanical ventilation
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| ===Special Instructions===
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| '''Flying'''
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| *Can consider flying 2 weeks after full resolution of traumatic pneumothroax<ref name="BTC"></ref>
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| ==See Also== | | ==See Also== |
| *[[Chest Tube]] | | *[[Pneumomediastinum]] |
| | *[[Chest tube]] |
| *[[Thoracentesis]] | | *[[Thoracentesis]] |
| *[[Thoracic Trauma]] | | *[[Thoracic trauma]] |
| *[[Hemothorax]] | | *[[Hemothorax]] |
| | *[[Deterioration After Intubation (DOPE)]] |
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| ==Source== | | ==References== |
| *Roberts and Hedges Clinical Procedures in Emergency Medicine
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| *Rosen's
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| *American College of Chest Physicians Consensus Statement
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| <references/> | | <references/> |
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| [[Category:Pulm]] | | [[Category:Pulmonary]] |
| [[Category:Trauma]] | | [[Category:Trauma]] |
