Traumatic Pneumothorax

Dr F Morris

Overview

Case scenario

Chest emergencies

Chest drain vs conservative

Chest drain insertion

Cardiothoracic advice

A tale of two 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.

Chest injuriesA Airway obstruction 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

Current evidenceReabsorption 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.

Current evidence

Data on traumatic pneumothorax management are limited.

BTS BSP ACCP

<2cm Small + minimally symptomatic -

Aspiration Aspiration Chest drain

Chest drain

Needle vs finger thoracotomy

Suture pack?

Tube size

Big - 26-28Fr

Bigger - up to 40Fr!

Cardiothoracics

Consult for any patient with rib fractures:

intercostal n. and paravertebral blocks

ORIF / plating

Traumatic pneumothoraces

Big tubes!

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.