Types
- Simple: air in pleural space
- Tension: one-way valve effect
- Open: Sucking chest wound
Causes
- Spontaneous: rupture of blebs - asthmatics, skinny lanky
- Trauma
- Iatrogenic
Recognition
- Conscious
- Tachycardia, tachypnoea, decreased sats
- Tracheal deviation, hyper-resonance
- Surgical emphysema
- Unconcious / ventilated
- Sudden hypoxia
- Sudden increase in ventilatory pressures
- Sudden hypotension or rising CVP
- New arrythmia
Management
- Early recognition (esp tension)
- 100% O2
- Tension - needle decompression (2ICS)
- Chest drain
Pleurodesis
-
Performed endoscopically (VATS - video assisted thoracoscopic surgery)
-
Chemical
-
Physical - by abrasive pads: used for younger patients as chemical pleurodesis carries theoretical risk of increasing malignancy
Indications for Thoracotomy in Haemopneumothorax
(Persistent bleeding - usually from chest wall ~80%)
- Loss of >1500mls immediately into drain
- Loss of >200mls/hr for 2-4 hours
- Requirement for persistent blood transfusion