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1. What is pneumothorax and how is it classified?

Definition: Air trapped between a lung and chest wall (from lungs/ from outside body) => Limited lung expansion Symptom: Sudden pain on 1 side of chest, make worse by inspiration, may suffer from breathlessness, cough and fever Consequence: Other lung to cope with => Small tear healed within days => Air absorbed into bloodstream => Injured lung becomes normal again One way valve on wound => Air pumped in during inspiration but not out => Increased air volume and pressure => Push on lungs and heart (Tension pneumothorax)

Primary Spontaneous Pneumothorax: Unknown cause => Bleb on lung edge (usually near top of lung) => Tiny tear of outer part of lung => Escaped air trapped Common, especially in tall thin healthy young adults and smokers 30% Chance of recurrence Secondary Spontaneous Pneumothorax: Lung Diseased => Weakened lungs => Liable lung teared and air escaped As a complication of COPD (chronic obstructive pulmonary disease), Pneumonia, Tuberculosis, Sarcoidosis, Cystic fibrosis, Lung cancer and Idiopathic pulmonary fibrosis Other Causes of pneumothorax: Car crash, Stab wound to chest, Surgical operation, Endometriosis (Uncommon complication)

1. What is pneumothorax and how is it classified? Definition: Air trapped between a lung and

2.

What are the criteria for the diagnosis of pneumothorax?

Chest X-Ray

  • 3. How is pneumothorax treated?

Small: No treatment; X-Ray to check; Painkillers Large: Local anesthetic injection => Insert tiny tube => Air expelled into atmosphere Recurrence: Operation => remove bleb on lung surface; Irritant powder => Put on lung surface => Inflammation => Stick surface to chest wall

After you have found the answers to these questions, can you understand what happened on board the British Airway flight? Why the situation was life‐threatening and the woman had to be treated immediately in flight?

Pneumothorax: Accumulation of air/ gas in pleural space by rupture of pleural membrane/ chest wall

3 Prop of lung: Compliance, surface tension, elasticity Mercury-> Measure absolute pressure (in mmHg)

Water-> Measure relative pressure (in cmH2O) Apex-base Pip gradient: 753 to 758 mmHG/ -2.5 to -10 cmH2O (Due to gravity) Pip is taken the average value (756 mmHG)(-5 cmH2O)

Ptp = Pa Pip

TransPulmonary, Alerolar, IntraPleural

Classification 1) Spontaneous - Primary: Healthy otherwise exist Spontaneous - Secondary: In lung diseased

2) Traumatic: For example, car crash 3) Iatrogenic: By medical procedure

Classification by mechanism (By Pip)(Normally -5 cmH2O) 1) Closed: Sealed pleural cavity with no air flow, only accumulation (Pip<0) 2) Open: Air movement in and out pleural space constantly through rupture (Pip=0) 3) Valvular/ Tension: Air in during inspiration, but do not go out due to a one-way valve (Pip>0)

Diagnosis 1) X Ray: Symmetry of chest wall/ Shift of mediastinal membrane 2) Stethoscope: Breathing sound (Trapped air)

Treatment 1) Observation: Heal after days 2) Aspiration

3) Chest tube/ Intercostal tube insertion (Water-seal Drainage System)

  • - Closed: Water meniscus rises

  • - Tension: Air bubble released into water

  • - Open: Nothing observed

Management 1) Evidence of tension (eg CV collapse) If yes -> 2 If no -> 3 2) Immediate cannulation n tube drainage 3) Chronic lung disease? If yes -> 4 If no -> 7 4) Lung collapse? Significant dyspnea (Difficult breathing)? If yes -> 5 If no -> 6 5) Percutaneous needle aspiration If yes ->8 If no -> 9 6) Inpatient observation 7) Lung collapse? Significant dyspnea (Difficult breathing)? If yes -> 5

If no -> 8 8) Outpatient follow-up 9) Intercostal tube drainage