Xray Vision: Chest Pain Answer

by sliang • June 26, 2015 • Comments Off

Check out the original post here: Xray Vision: Chest Pain

Congratulations Dr. Grundmann! This patient has a primary spontaneous pneumothorax.

Classification

-size of pneumothorax can be calculated from various formulas such as the Light Index but it has not shown to be accurate

-per American College of Chest Physicians, a small pneumothorax is ≤3 cm from the thoracic apex to lung cupola

-per British Thoracic Society, small is considered to be <2cm from thoracic apex to lung cupola

Criteria for Stable Patient with Pneumothorax

Respiratory rate <24 breaths/min

No dyspnea at rest, speaks in full sentences

Pulse >60 and <120 beats/min

Normal blood pressure for patient

Oxygen saturation >90% on room air

Absence of hemothorax

Adapted from Henry M, Arnold T, Harvey J, et al: BTS guidelines for the management of spontaneous pneumothorax. Thorax 58: ii39, 2003; and Currie GP, Allrui R, Christie GL, Legge JS: Pneumothorax: an update. Postgrad Med J 83: 461, 2007.

Management

-depends more on clinical status than size of pneumothorax

-oxygen 3-10L helps increase resorption by 3-4 folds

Treatment of Pneumothorax

Condition	Treatment Options
Small primary pneumothorax	Observation for 6 h, discharge if no symptoms and return for check if symptoms reoccur or in 24 h
	or
	Small-size catheter aspiration with immediate catheter removal, then observe for 6 h, discharge if no symptoms and return for check if symptoms reoccur or in 24 h
	or
	Small-size catheter or small-size chest tube insertion, Heimlich valve or water-seal drainage, and admission
Small secondary pneumothorax	Small-size catheter or small-size chest tube insertion, Heimlich valve or water-seal drainage, and admission
Large pneumothorax, either primary or secondary, or bilateral pneumothoraces	Moderate-size chest tube and admission; large-size chest tube if fluid or hemothorax present; water-seal drainage and admission
Tension pneumothorax	Immediate needle decompression followed by moderate or large-size chest tube insertion, water-seal drainage, and admission

References: Humphries RL, Young W, Jr.. Chapter 71. Spontaneous and Iatrogenic Pneumothorax. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011.

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.