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Monday, November 26, 2012

Pneumothorax

Definition:
It is accumulation of air in the pleural cavity.

Classification of Pneumothorax:

A.     Spontaneous Pneumothorax:

The Pneumothorax that is not caused by trauma is called spontaneous Pneumothorax. It is divided into primary and secondary Pneumothorax.

a.       Primary Pneumothorax:

It usually occurs in young thin people usually due to deficiency in elements of wall of alveoli.

b.      Secondary Pneumothorax:

It occurs due to a pre-existing lung disease i.e. COPD, TB, lung Abscess, Bronchiectasis

B.     Traumatic Pneumothorax:

It occurs due to Trauma also included pleural biopsy, bronchoscopy etc.

C.     Tension Pneumothorax:

Basically there is ball valve mechanism involved in it.

Clinical features:

Ø  Breathless
Ø  Pain
Ø  Tachypnea
Ø  Percussion is hyper-resonance
Ø  Decreased chest wall movement depending on the extent of Pneumothorax

Management of Pneumothorax:

 

For Young:

o   If the patient is young having air rim > 2 cm, ⁺breathless  -   if no features -     there is no need of treatment.           
                                                if features are present  
o    Then aspirate by three way cannula           -               If Pneumothorax resolved send patient to home

If attempt failed
o   -Again aspirate by three way cannula            -              If Pneumothorax resolved send patient to home
                                                If again failed

o   Then insert an intercostals tube with under water seal.

For Old:

o   If the patient is old > 55 years age having air rim > 2 cm, ⁺breathless -    if no features    -  there is no need of treatment.         
                                                if features are present  

o   Then aspirate by three way cannula            -              If Pneumothorax resolved send patient to home
                                                If attempt failed
o   Again aspirate by three way cannula            -              If Pneumothorax resolved send patient to home
                                                If again failed

o   Then insert an intercostals tube with under water seal.

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