Pneumothorax

• Presence of air in the pleural space
• Primary pneumothorax: spontaneous in young thin male due to rupture of a subpleural bulla
• Secondary pneumothorax: chronic lung disease, infection, trauma, carcinoma, connective tissue disorder

Signs and Symptoms

• Signs: asymptomatic or sudden onset pleuritic chest pain, dyspnoea
• Symptoms: reduced chest expansion, hyperresonance to percussion, reduced breath sounds
• Tension pneumothorax will present with trachea deviation to the opposite side

Investigation

• Tension pneumothorax should proceed to initial treatment straightaway
• Simple pneumothorax: CXR and consider ABG

Management

• Simple pneumothorax
  

  

• Tension pneumothorax
  • Insert a large-bore (14-16G) needle with a partially filled syringe (NSS) into the 2nd intercostal interspace in the midclavicular line and allow air to bubble through
  • Then insert a chest drain

Reference: British Thoracic Society