Pneumothorax

Question 1

What does Marfan’s syndrome increase the risk for?

Answer 1

Acute aortic dissection or rupture

Question 2

Which pneumothorax tends to have no tracheal deviation?

Answer 2

Primary pneumothorax

Question 3

How is pneumothorax that is less than 2cm managed?

Answer 3

Conservatively or
Pleural aspiration

Question 4

How is a pneumothorax 2cm or larger managed?

Answer 4

If symptomatic, they require a chest drain

Question 5

When should follow up occur?

Answer 5

Outpatient clinic 2-4 weeks after presentation, and they require another chest image

Question 6

How long are patients not permitted to fly on a plane?

Answer 6

7 days

Question 7

How long are patients not permitted to dive for?

Answer 7

For life

Question 8

Where is emergency needle compression located?

Answer 8

5th intercostal space, mid axillary line on the side of the pneumothorax

Question 10

What is the first management of tension pneumothorax?

Answer 10

NEEDLE THORACENTESIS 5TH INTERCOSTAL SPACE MID AXILLARY LINE.

THEN, you would do a chest drain if they have co-morbiiies

Question 11

What should always be performed prior to chest drain?

Answer 11

Needle throacentesis

Question 12

When can needle decompression in 2nd ICS mid-clavicular line be performed?

Answer 12

Non traumatic pneumothorax

Question 13

What to do for low risk pneumothorax?

Answer 13

Low risk is asymptomatic and less than 2cm. Depends on patient preferences:
Discharge with outpatient follow up in 2 weeks
OR
Aspiration with 16g cannula

Question 14

What to do if initial management is unsuccessful for low risk?

Answer 14

if aspiration is unsuccessful, chest drain insertion

Question 15

What to do for high risk pneumothorax?

Answer 15

Chest drain

Question 16

What is the management of symptomatic patients with 2cm or larger pneumothorax?d

Answer 16

Depends o priorities
Conservative managmeent if wanting to avoid needle

Needle aspiration

Ambulatory devices

Question 17

What are the ambulatory devices?

Answer 17

One way valve that allows air to eave pneumothorax and patient can be followed up as outpatient

Question 18

Where is the location of pneumothorax?

Answer 18

Between visceral and parietal pleura

Question 19

How does a tension pneumothorax present compared to classic pneumothorax?

Answer 19

Absent breath sounds
Tracheal deviation
Haemodynamic instability

Question 20

What causes a non-deviated pneumothorax?

Answer 20

Primary spontaneous

Question 21

How to assess chest drain fluid?

Answer 21

Fluid should be bubbling and swinging with breathing

Question 22

What should be done for secondary pneumothorax?

Answer 22

Definitive management with chest drain or surgical pleurodesis

Question 23

What shold be used for persistent air leaks in patinets not fit fo surgical intervention?

Answer 23

Chemical pleurodesis

Question 24

What are the high risk characteristics for pneumothorax?

Answer 24

haemodynamic compromise (suggesting a tension pneumothorax)
significant hypoxia
bilateral pneumothorax
underlying lung disease
≥ 50 years of age with significant smoking history
haemothorax

Question 25

What is the ambulatory device?

Answer 25

typically have a one-way valve and vent to prevent air and fluid return to the pleural space while allowing for controlled escape of air and drainage of fluid

Question 26

How does tension pneumothorax affect the heart?

Answer 26

reduced cardiac filling: The direct pressure on the heart, coupled with reduced venous return, impairs both right and left ventricular filling. This can precipitantly lower cardiac output and systemic blood pressure

Question 27

What must be done first in traumatic pneumothorax?

Answer 27

Needle thoracostomy for decompression -> Urgent CXR is uncessary

Question 28

What is the management of less than 2cm pneumothorax which is secondary?

Answer 28

Conservative management with inpatient monitoring

Question 29

What is a contraindication for chest drain insertion?

Answer 29

INR over 1.3

Question 30

What is needle decompression used for?

Answer 30

Tension pneumothorax

Question 31

What is aspiration used for?

Answer 31

Rapid relief os symptoms

Question 32

What causes a patient to become breathless hours after a chest drain that is bloodstained?

Answer 32

Pneumothorax

Question 33

What causes a patient to become breathless hours with frank blood?

Answer 33

Haemothorax

Question 34

How does trachea position indicate type of pneumothorax?

Answer 34

Central pneumothorax means that there is no haemodynamic compromise that helps to rule out tension pneumothorax.

Question 35

When to do pleural aspiration VVI pleural chest drain insertion?

Answer 35

Pleural aspiration is ideal for symptomatic relief. However, more severe pleural effusions with significant respiratory distress should use chest drain.

Question 37

What are high risk characteristics for pneumothorax?

Answer 37

Haemodynamically compromise from tension pneumothorax Significant hypoxia Bilateral pneumothorax Underlying lung disease Over 50 with significant smoking history Haemopneumothorax

Question 38

How to manage symptomatic spontaenous pneumothorax patient with high risk features

Answer 38

Chest drain and admission for monitoring

Question 39

How is spontaneous pneumothorax which is asymptomatic generally managed?

Answer 39

Conservative management and ambulatory devices like pleural devices

Question 40

What is the site of insertion for tension pneumothorax?

Answer 40

Fifth intcostal space, mid-axillary line

Question 41

What is the needle insertion for a non traumatic tension pneumothorax?

Answer 41

Insert a 14-16G needle into the 2nd intercostal space, mid-clavicular line of the left side

Question 42

When does pneumothorax get classified into a different condition?

Answer 42

After 48 hours, it is considered a persistent alveolar leak, so managed with thoracic surgery

Question 43

What to do if chest drain is not bubbling

Answer 43

Not patent so requires flushing

Question 44

How to manage a failed aspiration of PRIMARY pneumothorax?

Answer 44

Insertion of chest drain is

Question 45

When is needle decompression inappriroouate?

Answer 45

Ptimstu ppneumothorax

Question 46

What are the high risk features for pneumothorax?

Answer 46

*Bilateral pneumothorax *Signficant hypoxia * Haemothorax * Over 50 with significant smoking history * underlying lung disease

Question 47

What to do for asymptomatic pneumothorax in patient with a pre-existing lung ocnidiotn?

Answer 47

Keep in hospital as an inpatient

Question 48

How long to avoid air trabel with pneumothorax?

Answer 48

patients may travel 2 weeks after successful drainage if there is no residual air 1 week post check x-ray

Question 49

How to conservatively manage low risk pneumothorax?

Answer 49

should be reviewed every 2-4 days as an outpatient

Question 50

What may be m

Question 51

What can pneumothorax be mistaken for in COPD patients?

Answer 51

Bullae

Question 52

What to do if chest drain does not resolve symptoms?

Answer 52

Refer for video-assisted thoracoscopic surgery to allow for mechanical/chemical pleurodesis +/- bullectomy