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Traumatic Pneumothorax Management
1. The document discusses management of traumatic pneumothoraces, specifically comparing conservative management versus chest drain insertion. Current evidence and guidelines from organizations like BTS and ACCP are limited, with small pneumothoraces under 2cm often managed conservatively with aspiration while larger ones typically require a chest drain. 2. Chest drain insertion involves consideration of needle versus finger thoracotomy and proper tube size, often larger at 26-28Fr or even up to 40Fr for trauma. Cardiothoracic consultation is recommended for any patient with rib fractures to consider procedures like open reduction internal fixation or intercostal nerve blocks. 3. Traumatic pneumothoraces often require larger chest tubes and consultation is
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Traumatic Pneumothorax Management
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- 2. Overview Case scenario Chest emergencies Chestdrain vs conservative Chest drain insertion Cardiothoracic advice
- 3. A tale oftwo chests 1. 25M BIBA 0400hrs; MVA, driver, found at roadside: Sternal tenderness 2. 30M AFL player crunched in chest on live TV: Paradoxical chest wall movement.
- 9. Chest injuries A Airwayobstruction Aortic injury T Tension pneumothorax Thorax injuries O Open pneumothorax Oesophageal perforation M Massive haemothorax Muscular diaphragmatic injury F Flail segment + contusion Fistula or other tracheobronchial injury C Cardiac tamponade Contusion to heart or lungs
- 10. Current evidence Reabsorption estimate:1.25%/24hrs. No completed RCTs for conservative vs intervention Pro: shorter hospital stay, normalisation of CXR Caveat: frequency of complication, analgesia requirement, recurrence risk.
- 11. Current evidence Data ontraumatic pneumothorax management are limited. BTS BSP ACCP <2cm Small + minimally symptomatic - Aspiration Aspiration Chest drain
- 12. Chest drain Needle vsfinger thoracotomy Suture pack? Tube size Big - 26-28Fr Bigger - up to 40Fr!
- 13. Cardiothoracics Consult for anypatient with rib fractures: intercostal n. and paravertebral blocks ORIF / plating Traumatic pneumothoraces Big tubes!
- 16. References 1. Ashby M,Haug G, Mulcahy P, Ogden KJ, Jensen O, Walters JAE. Conservative versus interventional management for primary spontaneous pneumothorax in adults. Cochrane Database of Systematic Reviews 2014, Issue 12 2. McGonigal M. “Chest tube for trauma” Life In The Fast Lane March 2012 3. Brasel KJ, Stafford RE, Weigelt JA, Tenquist JE, Borgstrom DC. Treatment of occult pneumothoraces from blunt trauma. Journal of Trauma-Injury & Critical Care June 1999, Vol 46, Issue 6, pp987-991.