Traumatic Pneumothorax Management

Traumatic Pneumothorax Management

1. Traumatic Pneumothorax Dr F Morris

2. Overview Case scenario Chest emergencies Chest drain vs conservative Chest drain insertion Cardiothoracic advice

3. A tale of two chests 25M BIBA 0400hrs; MVA, driver, found at roadside: Sternal tenderness 30M AFL player crunched in chest on live TV: Paradoxical chest wall movement.

4. Chest injuries A 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

5. 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.

6. Current evidence Data on traumatic pneumothorax management are limited. BTS BSP ACCP <2cm Small + minimally symptomatic - Aspiration Aspiration Chest drain

7. Chest drain Needle vs finger thoracotomy Suture pack? Tube size Big - 26-28Fr Bigger - up to 40Fr!

8. Cardiothoracics Consult for any patient with rib fractures: intercostal n. and paravertebral blocks ORIF / plating Traumatic pneumothoraces Big tubes!

9. References 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 McGonigal M. “Chest tube for trauma” Life In The Fast Lane March 2012 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.