Pneumothorax CCC
OVERVIEW
- Spontaneous – primary (no disease) and secondary (underlying lung disease)
- Traumatic – non-iatrogenic and iatrogenic (barotrauma and procedure related)
CAUSES
- many!
CXR FINDINGS
Supine
- Hyperlucency in anteromedial and subpulmonic recesses
- Visualisation of visceral pleural
- Deep sulcus sign
Tension (radiological)
- increased volume of hemithorax
- depressed hemidiaphragm
- tracheal deviation
MANAGEMENT
- tension: decompress immediately
- minimal symptoms, < 3cm -> O2 and observe
- symptomatic, > 3cm -> small bore chest drain
- if persistent after 10 days of an ICC: look for foreign body, tumour or mucus plug -> call cardiothoracic surgeon for VAT’s
References and Links
- Ultrasound – Lung ultrasound: Pneumothorax and example Case
- Brims F. Tension pneumothorax – time to change the old mantra? LITFL
- Johnston M. Searching for Smaug. LITFL
- Brims F. Tension Pneumothorax – an alternative view. LITFL
- Own the Chest Tube. CCC
- Rippey J. Lung ultrasound: Pneumothorax. LITFL
- Nickson C. Pneumothorax. CCC
- Top 100 CXR
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Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC