PNEUMOTHORAX

This occurs when air enters the plural space, causing lung collapse on the affected side.

Causes include

  • Spontaneous development following staphylococcal pneumonia due to chronic obstructive pulmonary disease.
  • Rib fractures and or lung contusion
  • Penetrating injuries
  • Stab wounds, and missiles.

Clinical Features

  • There is shortness of breath
  • Tightness of the affected chest
  • Tachypnoea, and tachycardia.
  • Sweating and cyanosis may be present.
  • Reduced chest excursion also occurs, with reduced air entry on auscultation.
  • Hyper-resonant chest is noted on percussion.

Investigations

  • Chest radiograph: Shows various degrees of lung collapse.

Management

  • If more than 5% pneumothorax, institute tube thoracostomy drainage (underwater seal drainage); maintain absolute sterility while performing the procedure.
  • Chest tube may be removed when the lung is fully expanded and remains fully expanded after test clamping the chest tube for a number of hours.
  • Tension pneumothorax needs more rapid treatment with immediate insertion of a wide bore cannula drainage or underwater seal drainage under local anaesthesia.
    • Tension pneumothorax is a clinical diagnosis and not a radiological diagnosis. Ordering a chest radiograph may result in patient death before active treatment can be implemented.
  • An associated frail chest leads to paradoxical breathing and may require assisted ventilation (i.e., intermittent positive pressure ventilation), if features of respiratory failure develop