PNEUMOTHORAX
INVESTIGATIONS AND
MANAGEMENT
INVESTIGATIONs


Chest X ray :sharply defined edge of deflated lung with
complete translucency.



Chest X ray will also...
Chest X ray : pneumothorax
MANAGEMENT

p1

MEDIASTINAL SHIFT/TENSION PNEUMOTHORAX

ICD

YES

ICD

YES

ICD

YES

PNEUMOTHORAX
15% OF
HEMITHORAX/SIGN
...
NO

PERCUTANEOUS NEEDLE ASPIRATION

NO

GREATER THAN 2.5 L AIR ASPIRATED OR
PNEUMOTHORAX PERSISTS

ICD

YES

NO

OBSERVE P...
MANAGEMENT

p2



Primary pneumothorax : when lung edge is less than 2 cm from
chest wall and patient is not breathless n...
PERCUTANEOUS NEEDLE
ASPIRATION OF AIR
PNEUMOTHORAX
MANAGEMENT

p3



When needed ICD is done in 4,5,6 IC space in MAL following
Blunt dissection to pleura.



Tube should ...
Intercostal drainage
MANAGEMENT

p4



Recurrent pneumothorax: patient is advised to stop
smoking as it is a RISK factor for pneumothorax.


...
PLEURODESIS

BEFORE AND AFTER ICD

END
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PNEUMOTHORAX fahad basheer

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this is my presentation of pneumothorax that I presented in my gen medicine class, I includes investing and management only of pneumothorax


best of luck

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PNEUMOTHORAX fahad basheer

  1. 1. PNEUMOTHORAX INVESTIGATIONS AND MANAGEMENT
  2. 2. INVESTIGATIONs  Chest X ray :sharply defined edge of deflated lung with complete translucency.  Chest X ray will also show any extent of any mediastinal displacement and give information regarding presence or absence of pleural fluid  Care must be taken in order to differentiate between pneumothorax and emphysematous bullae to avoid a misdirected attempts of aspiration.  if any doubts GO for CT scan : CT scan help-s to differentiate between bullae and pleural air.
  3. 3. Chest X ray : pneumothorax
  4. 4. MANAGEMENT p1 MEDIASTINAL SHIFT/TENSION PNEUMOTHORAX ICD YES ICD YES ICD YES PNEUMOTHORAX 15% OF HEMITHORAX/SIGN IFICANT DYSPNOEA NO CHRONIC LUNG DISEASE GREATER THAN 50 YEARS OF AGE NO YES
  5. 5. NO PERCUTANEOUS NEEDLE ASPIRATION NO GREATER THAN 2.5 L AIR ASPIRATED OR PNEUMOTHORAX PERSISTS ICD YES NO OBSERVE PATIENT FOR 6 HOURS OUTPATIENT FOLLOW UP
  6. 6. MANAGEMENT p2  Primary pneumothorax : when lung edge is less than 2 cm from chest wall and patient is not breathless normally resolves without intervention.  Young patients : we do PNA of air rather than ICD tube.  Patient with underlying Chronic lung disease: small secondary pneumothorax may cause respiratory failure. THIS type of patients require ICD  In Tension Pneumothorax :immediate decompression is requires prior to insertion of intercostal drain.  Aspiration : is done in 2nd intercostal space anteriorly in MCL using 16 F cannula.
  7. 7. PERCUTANEOUS NEEDLE ASPIRATION OF AIR PNEUMOTHORAX
  8. 8. MANAGEMENT p3  When needed ICD is done in 4,5,6 IC space in MAL following Blunt dissection to pleura.  Tube should be connected to an underwater seal  Should be secured firmly on chest wall  Drain should be removed 24 hr. after lung has fully re inflated and bubbling stopped. Continued bubbling after 5-6 days is an indication for surgery. If bubbling in under water bottle is stops prior to full re inflation the tube is either blocked, kinked or displaced. *ALL patients should receive supplemental oxygen as this accelerates the rate at which air is reabsorbed from pleura.   
  9. 9. Intercostal drainage
  10. 10. MANAGEMENT p4  Recurrent pneumothorax: patient is advised to stop smoking as it is a RISK factor for pneumothorax.  Flying and diving are RISK factors for recurrent spontaneous pneumothorax.  Surgical pleurodesis is recommended for all patients following the 1st episode of secondary pneumothorax  Pleurodesis is achieved by parietal pleurectomy at thoracotomy or thoracoscopy
  11. 11. PLEURODESIS BEFORE AND AFTER ICD END

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