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Pneumothorax
A randomised controlled trial of invasive versus conservative treatment of primary spontaneous pneumothorax (PSP) Professor Simon Brown, Dr Emma Ball ACTRN12611000184976
PSP
Primary Spontaneous Pneumothorax
Clearly more common in males and tall people
Watch out for Marfans Syndrome/Ehlers Danlos
Bleb
Images courtesy of Society of American Gastrointestinal and Endoscopic Surgeons
PSP
• Occasionally almost asymptomatic
• Seldom causes saturations below 92%
• Most patients notice dyspnoea on exercise
• Many recall previous episodes
Chance of recurrence
Widely quoted at 30 % after first PSP
• 60% after second
• 80 after third
Higher if you won’t stop smoking
Diving and flying
Flying thought to be ok one week after resolution (BTS guideline)
Diving- never unless pleurodesis performed
Image courtesy kuvatON.com
Blebectomy , bullectomy, apical stapling, pleurectomy or pleurodesis
Images courtesy of Society of American Gastrointestinal and Endoscopic Surgeons
Long term safety pleurodesis
Slight restrictive ventilatory defect
Talc now less popular
Intercostal Chest Catheters
It hurts!!
Complications of ICCs
Courtesy of the ICN
Where did it go!!?!??!!!?
Seldinger technique makes it safer right?
Ventricular drainage
More Complications
The PSP study
• Intubation in space picture
Typical
• Typical one
• Bilateral one
• Small effusion
• Shift with exp view
• Real tpx
TensionPX
Never take an XR of this!!
The trachea is deviated
There is hyper-resonance
The great vessels kink and blood pressure collapses
TPX
• Said to be present in 5% of retrieved trauma patients
• Did it hiss?
17 mmhg
Reliable signs of TPX
Chest pain
Respiratory distress
70% of tensions
Tachycardia
Decreased air entry
Seldom present /unreliable in TPX
Hypotension
Tracheal deviation
Hypoxia/cyanosis
TPX in a ventilated patient
A more typical precipitous collapse
Ventilatory failure followed by hypotension
Needle decompression