Pneumothorax

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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?

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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

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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

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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

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Investigations

  • lab investigations
  • diagnostic imaging

Lab Investigations

Diagnostic Imaging

 

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Differential Diagnosis

 

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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

Second occurrence: surgery (often video-assisted VATS procedure)

 

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Consequences and Course

 

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The Patient

 

Appreciate their perspective experiences when considering offering medications of any type. Some may choose Naturopathic approaches to prevention and treatments.

 

 

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Health Care Team

 

 

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Community Involvement

 

 

 

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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).

 

 

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Topic Development

created:

authors: David LaPierre, Paul Brett Nissen

editors: Paul Brett Nissen

reviewers:

 

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