What differentiates primary and secondary pneumothoraces?
Secondary pneumothoraces occur in those with existing lung disease and should be considered in those over 50 years old, with a smoking history or changes on examination or visible on the CXR.
What criteria are considered when managing pneumothoraces?
With any unwell patient, an ABC approach should be followed. If primary and over 2 cm, needle aspiration can be performed - otherwise observe or discharge with follow up. If secondary and 1-2 cm, treatment is again needle aspiration however if larger than 2 cm or the patient is breathless or shows other signs of respiratory distress, then chest drain insertion is the treatment of choice. All these patients should be supported with oxygen.
Who should be involved in the management of these patients - and especially when chest drains are being considered?
This is becoming a hot topic in acute care and in our units, the only staff who should be performing chest drain insertion in adults are respiratory doctors - due to the relative infrequency of these procedures for other clinicians and potential complications.
Large left sided pneumothorax (7 cm at level of left hilum) with collapse of left lung structures.
Some mediastinal divergence from midline - possible tension pneumothorax.
Right lung clear.