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| Line 2: |
Line 2: |
| *[[Spontaneous pneumothorax]] | | *[[Spontaneous pneumothorax]] |
| *[[Tension pneumothorax]] | | *[[Tension pneumothorax]] |
| | *[[Traumatic pneumothorax]] |
| [[File:Pneumothorax.jpeg|thumbnail]] | | [[File:Pneumothorax.jpeg|thumbnail]] |
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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== |
