Traumatic Pneumothorax Management

1. Traumatic
Pneumothorax
Dr F Morris

2. Overview
Case scenario
Chest emergencies
Chest drain vs conservative
Chest drain insertion
Cardiothoracic advice

3. A tale of two chests
1. 25M BIBA 0400hrs; MVA, driver, found at
roadside:
Sternal tenderness
2. 30M AFL player crunched in chest on live TV:
Paradoxical chest wall movement.

9. Chest injuries
A Airway obstruction Aortic injury
T Tension pneumothorax Thorax injuries
O Open pneumothorax Oesophageal perforation
M Massive haemothorax Muscular diaphragmatic injury
F Flail segment + contusion
Fistula or other
tracheobronchial injury
C Cardiac tamponade Contusion to heart or lungs

10. Current evidence
Reabsorption estimate: 1.25%/24hrs.
No completed RCTs for conservative vs intervention
Pro: shorter hospital stay, normalisation of CXR
Caveat: frequency of complication, analgesia
requirement, recurrence risk.

11. Current evidence
Data on traumatic pneumothorax management
are limited.
BTS BSP ACCP
<2cm
Small + minimally
symptomatic
-
Aspiration Aspiration Chest drain

12. Chest drain
Needle vs finger thoracotomy
Suture pack?
Tube size
Big - 26-28Fr
Bigger - up to 40Fr!

13. Cardiothoracics
Consult for any patient with rib fractures:
intercostal n. and paravertebral blocks
ORIF / plating
Traumatic pneumothoraces
Big tubes!

16. References
1. Ashby M, Haug G, Mulcahy P, Ogden KJ, Jensen O, Walters JAE. Conservative
versus interventional management for primary spontaneous pneumothorax in adults.
Cochrane Database of Systematic Reviews 2014, Issue 12
2. McGonigal M. “Chest tube for trauma” Life In The Fast Lane March 2012
3. Brasel KJ, Stafford RE, Weigelt JA, Tenquist JE, Borgstrom DC. Treatment of occult
pneumothoraces from blunt trauma. Journal of Trauma-Injury & Critical Care June
1999, Vol 46, Issue 6, pp987-991.