Pneumothorax and its management

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Pneumothorax means “air” in the pleural space.

Pathology

 

1. Chest Trauma

2. Spontaneously occurs in

  • Chronic bronchitis.
  • Emphysema.
  • Bronchial asthma.
  • Carcinoma.
  • Lung Abscess

Clinical Features

  • Sudden onset of unilateral pleuritic chest pain and increasing breathlessness are usual complaints.
  • Severe cases have pallor & tachycardia.
  • Decreased chest movements in affected side.
  • Trachea is displaced to healthy side.
  • Percussion note is hyper-resonant.
  • On auscultation, there is no air entry on affected side.

Investigations

X-Ray chest PA view shows collapsed lung with mediastinal shift.

Treatment:

Depends upon severity of disease

  • In mild pneumothorax, no active treatment, just avoid severe exercise & after two weeks, air is absorbed simultaneously.
  • In severe cases e.g. Tension Pneumothorax; aspirate air by inserting wide-bore needle in 4th intercostal space in midclavicular line followed by intercostal drainage tube with underwater seal in the triangle of safety  for 2-3 days.  Review the tube if pneumothorax is not resolved.  Surgery in the form of pleurectomy or pneumolysis.

Indications of Thoracotomy in Chest Trauma

 

  1. More than 1000 ml on initial intubation
  2. 200-300 ml/h over a period of time
  3. Signs of cardiac temponade
  4. Evidence of any visceral injury