Pneumothorax
last authored:
last reviewed:
Introduction
The Case of Brent Nosin
Mr Nosin is a 27 year-old man who experiences worsening chest pain and shortness of breath. He travels to the emergency department, where a chest X-ray is done suggesting pneumothorax.
question: how could this have happened? what treatments should be considered?
Causes and Risk Factors
Spontaneous (stretching and ripping of apical)
COPD
AIDS, CF, LAM
iatrogenic (central line, lung biopsy)
trauma
tall, slender males ages 18-35
first occurrence: 25% chance of recurrence
Tension pneumothorax
- positive pressure
Pathophysiology
With entry of air into the pleural space, pleural pressure moves from -5 to 0 as the lungs collapse inward and the chest springs outward.
With tension
- decreased venous return and cardiac output; compressed contralateral lung
Signs and Symptoms
- history
- physical exam
History
Physical Exam
tension
- distress
tympanitic hemithorax
decreased or absent breath sounds
apex beat displaced
distended neck veins
hypotension
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Differential Diagnosis
Treatments
Tension pneumothorax
Needle in 2nd intercostal space, mid clavicular line, followed by a chest tube
Spontaneous
First occurrence: chest tube if >20% (chest tube with hymlic valve) ; if not, observation
- surgery if bilateral, diver, flyer, isolated environment, third world travel, common in airline attendants
Second occurrence: surgery (often video-assisted VATS procedure)
Consequences and Course
The Patient
Appreciate their perspective experiences when considering offering medications of any type. Some may choose Naturopathic approaches to prevention and treatments.
Health Care Team
Community Involvement
Resources and References
Consider patients experiences with working environments where smokers were present (ie: furniture moving company with co-workers who smoked pipes and cigars and other CO2 exhaled substances).
Topic Development
created:
authors: David LaPierre, Paul Brett Nissen
editors: Paul Brett Nissen
reviewers:
 |