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 in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC