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Pneumothorax

Pneumothorax. Tintinalli Chapter 71. Epidemiology. 20,000 spontaneous ptx every year Risk factors Male Smoker Trimodal peaks: neonates, 20-40 yrs, >40. Pathophysiology. Iatrogenic Trauma or diagnostic procedure Spontaneous Primary: 2/3 No known lung disease Secondary

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Pneumothorax

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  1. Pneumothorax Tintinalli Chapter 71

  2. Epidemiology • 20,000 spontaneous ptx every year • Risk factors • Male • Smoker • Trimodal peaks: neonates, 20-40 yrs, >40

  3. Pathophysiology • Iatrogenic • Trauma or diagnostic procedure • Spontaneous • Primary: 2/3 • No known lung disease • Secondary • Underlying lung disease • Air enters potential space between parietal and visceral pleura

  4. Clinical features • Symptoms relate to size of ptx, rate of development, underlying clinical status • Acute pleuritic chest pain, dyspnea, ↓ BS • Tachycardia, tachypnea, hypotension if large and have underlying disease • Tension: tracheal deviation and hemodynamic compromise • Hypoxia

  5. Diagnosis • Imaging • CXR • 83% sensitivity • CT • May be needed to confirm if small • US • Signs of pneumo on US include: • Absence of lung sliding • Multiple horizontal artifact lines • Absence of vertical comet tail artifacts

  6. Treatment • Small and stable ptx • May be able to monitor with no intervention • Catheter aspiration • Small sized catheter • Cook catheter • Uresil • Chest tube thoracostomy • Large, secondary ptx, recurrent ptx, abnormal vitals

  7. Disposition • Recurrence • Definitive treatment may be required • Pleurodesis/VATS • High rate of recurrence, lower cost, high success, better quality of life

  8. Iatrogenic PTX • Transthoracic needle procedures (thoracentesis and transthoracic needle bx) • 50% • Subclavian vein lines • 25% • Factors • Underlying disease, body habitus, operator experience • Post procedure CXR may miss since may be delayed presentation • Treatment • Chest Tube

  9. Sources • Tintinalli, Ch. 71

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