Respiratory Medicine in Dundee
Questions about Pneumothorax
1) The commonest presenting symptoms are acute pleuritic pain and breathlessness.
CORRECT!
Must remember pneumothorax as a potential cause of symptoms in an asthmatic patient – it is the prime reason for doing a chest X-Ray in these patients
Incorrect
2) The most reliable sign is asymmetrically reduced breath sounds.
CORRECT!
Other signs include reduced expansion and hyper-resonance to percussion on the side of the pneumothorax
Incorrect
3) In a previously healthy chest an intercostal drainage tube is required for a pneumothorax of any size.
Incorrect
CORRECT!
If the patient is breathless and the rim of air around the lung edge on CXR is less than 2cm then the air can be aspirated with a needle. There is an algorithm for the management of pneumothorax which is too long to write here but can be found here.
Taken from the 2010 BTS Guidelines on Pleural Disease
4) A pneumothorax is easy to detect on clinical examination in acute COPD.
Incorrect
CORRECT!
With the breathlessness, wheeze, rapid respiratory rate and distress of the patient it can be difficult to pick up the more subtle signs of pneumothorax.
5) A swinging chest drain which continues to bubble should be clamped off.
Incorrect
CORRECT!
NEVER clamp a bubbling, swinging drain. Swinging means that the fluid in the underwater seal for the drain is moving up and down and indicates there is a direct connection from the drain to the pleural cavity. If there is bubbling then there is still an air leak from the lung and by clamping it off you will give the air nowhere to escape to so it could easily accumulate in the pleural cavity and cause a tension pneumothorax.
