II. Types
III. Pathophysiology
- Air enters potential space between the visceral pleura and the parietal pleura
-
Tension Pneumothorax may result
- Air accumulates in the pleural space with each breath taken
- Pressure compresses the lung tissue and inhibits venous return with secondary decreased Cardiac Output
IV. Causes: Adults
-
Blunt Chest Trauma
- Most common cause of sports-related Pneumothorax
- Consider other concurrent injuries (e.g. Pulmonary Contusion)
- Penetrating Chest Trauma
- Spontaneous Pneumothorax
- Iatrogenic Pneumothorax (secondary to medical procedure)
V. Risk Factors: Newborns (1-3% of births)
- Premature Infant
- Respiratory distress syndrome
- Meconium Aspiration Syndrome
VI. Signs
- See Spontaneous Pneumothorax (Simple Pneumothorax)
- See Open Pneumothorax
- See Tension Pneumothorax
- Decreased breath sounds
- Hyperresonance to percussion
VII. Imaging
- See Pneumothorax Imaging
-
Chest XRay
- Upright and end expiratory films are preferred
- Supine Chest XRay is unreliable and likely to yield a False Negative study
- Even large pneumothoraces on CT may be missed on Chest XRay
- Ultrasound
-
Chest CT
- See Nexus Chest CT Decision Rule in Blunt Trauma
- Gold standard in Pneumothorax
- Indicated where Chest XRay cannot distinguish bleb in COPD from Pneumothorax
- Identifies associated Traumatic Injury (e.g. multiple contiguous Rib Fractures)
VIII. Precautions
- Until a Chest Tube is placed, Tension Pneumothorax is a risk
- Do not perform Positive Pressure Ventilation, general Anesthesia or air transport until Pneumothorax decompression
- Consider Esophageal Rupture in the injured patient with a left Pneumothorax or Hemothorax without a Rib Fracture
IX. Management
- See Trauma Evaluation
- See Spontaneous Pneumothorax (includes disposition and restrictions)
- See Tension Pneumothorax
- See Open Pneumothorax
- See Hemothorax
- Non-Traumatic Pneumothorax
-
Traumatic Pneumothorax
- Chest Tube at 4-5th intercostal space at the mid-axillary line
- Confirm Chest Tube placement with Chest XRay
- Outside of Hemothorax (and hemopneumothorax), Small Caliber Chest Tubes appear safe in uncomplicated Traumatic Pneumothorax
- Small Caliber Chest Tubes are as effective and significantly less painful than standard Chest Tubes in Pneumothorax
- Kulvatunyou (2014) Br J Surg 101(2): 17-22 [PubMed]
- Chest Tube at 4-5th intercostal space at the mid-axillary line
X. Complications
XI. References
- Noppen (2003) Respiration 70(4): 431-8 [PubMed]
- Majoewsky (2012) EM:RAPC3 2(2): 3-4
- Tranchell (2013) Crit Dec Emerg Med 27(7): 11-8