Pneumothorax & chest tube final year mbbs lecture

By;Mr. Adeel Abbas

PneumothoraxCollapsed Lung.

The Presence Of Air Or Gas In The Cavity Between The Lungs And The Chest Wall, Causing Collapse Of The Lung.

Pneumothorax (Clinical Points)Shortness of Breath ± Pain.Tall Thin Male.Smoker.History of Travel.Trauma/COPD/Asthma/TB?

Breath Sounds?Vocal Resonance?Percussion?

Causes of PneumothoraxSpontaneous:

Primary; Idiopathic / Young Tall Men. Smoking / Familial.

Secondary; Lung Diseases (COPD/TB/Asthma/Cystic Fibrosis).

Traumatic (Blunt or Sharp Wound).

Iatrogenic (Central Venous Catheter Insertion).

Investigations;Chest X-Ray.

CT Scan.

D-Dimer.CT Pulmonary Angiography.

Tension PneumothoraxRespiratory Distress.Tracheal Deviation to Contralateral Side.Ipsilateral Decreased Breath Sounds.Hyper-Resonant.Raised JVP.Displaced Apex Beat.Hypotension.

Haemothorax Blood Accumulating In The Pleural Cavity.

Cause Is Usually Traumatic.

Massive HaemothoraxDrainage of >1500ml blood from chest

cavity on insertion of chest drain.

Shock.No Breath Sounds.Dull Percussion.JVP Raised? Decreased?

Treatment (Massive Haemothorax)Simultaneous Drainage of ;

Haemothorax.Fluid Resuscitation.

Wide Bore (>32 Fr) Chest Drain.

Thoracotomy?

Chest Drains

Indications;Air.Blood.Pus.Lymph.Fluid.Post-Thoracotmy.

Hazards;Damage to Intra-Thoracic Organs.Damage to Neurovascular Bundle.Infection.Subcutaneous Emphysema.Abnormally Placed Tube.

Care;Post-Procedure CXR.Never Use Trocar.Never Clamp the Drain.Drain Bottle Should Always be Below Chest Level.Pain Management.

Care; (cont.)Chest Physiotherapy.

Mr. ABC is 20 years old male with height of 6.5 feet. He has attended the emergency complaining of some left sided chest pain; there was no relief with paracetamol. He has recently made trip to Australia for diving. There is no significant medical or family history.

How would you investigate this patient?What signs would suggest a tension

pneumothorax?What are the causes of pneumothorax?