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

1. PNEUMOTHORAX
INVESTIGATIONS AND
MANAGEMENT

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. Chest X ray : pneumothorax

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. 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. 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. PERCUTANEOUS NEEDLE
ASPIRATION OF AIR
PNEUMOTHORAX

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. Intercostal drainage

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. PLEURODESIS
BEFORE AND AFTER ICD
END