1. What is pneumothorax and how is it classified?

Definition: Air trapped between a lung and chest wall (from lungs/ from outside
body) => Limited lung expansion
Symptom: Sudden pain on 1 side of chest, make worse by inspiration, may suffer
from breathlessness, cough and fever
Consequence: Other lung to cope with => Small tear healed within days => Air
absorbed into bloodstream => Injured lung becomes normal again
One way valve on wound => Air pumped in during inspiration but not out =>
Increased air volume and pressure => Push on lungs and heart (Tension
pneumothorax)

Primary Spontaneous Pneumothorax: Unknown cause => Bleb on lung edge (usually
near top of lung) => Tiny tear of outer part of lung => Escaped air trapped
Common, especially in tall thin healthy young adults and smokers
30% Chance of recurrence
Secondary Spontaneous Pneumothorax: Lung Diseased => Weakened lungs => Liable
lung teared and air escaped
As a complication of COPD (chronic obstructive pulmonary disease), Pneumonia,
Tuberculosis, Sarcoidosis, Cystic fibrosis, Lung cancer and Idiopathic pulmonary
fibrosis
Other Causes of pneumothorax: Car crash, Stab wound to chest, Surgical operation,
Endometriosis (Uncommon complication)
2. What are the criteria for the diagnosis of pneumothorax?

Chest X-Ray

3. How is pneumothorax treated?

Small: No treatment; X-Ray to check; Painkillers

Large: Local anesthetic injection => Insert tiny tube => Air expelled into atmosphere
Recurrence: Operation => remove bleb on lung surface; Irritant powder => Put on
lung surface => Inflammation => Stick surface to chest wall

After you have found the answers to these questions, can you understand what
happened on board the British Airway flight?
Why the situation was lifethreatening and the woman had to be treated
immediately in flight?

Pneumothorax: Accumulation of air/ gas in pleural space by rupture of pleural

membrane/ chest wall

3 Prop of lung: Compliance, surface tension, elasticity

Mercury-> Measure absolute pressure (in mmHg)
Water-> Measure relative pressure (in cmH2O)
Apex-base Pip gradient: 753 to 758 mmHG/ -2.5 to -10 cmH2O (Due to gravity)
Pip is taken the average value (756 mmHG)(-5 cmH2O)
Ptp = Pa Pip TransPulmonary, Alerolar, IntraPleural

Classification
1) Spontaneous - Primary: Healthy otherwise exist
Spontaneous - Secondary: In lung diseased
2) Traumatic: For example, car crash
3) Iatrogenic: By medical procedure

Classification by mechanism (By Pip)(Normally -5 cmH2O)

1) Closed: Sealed pleural cavity with no air flow, only accumulation (Pip<0)
2) Open: Air movement in and out pleural space constantly through rupture (Pip=0)
3) Valvular/ Tension: Air in during inspiration, but do not go out due to a one-way
valve (Pip>0)

Diagnosis
1) X Ray: Symmetry of chest wall/ Shift of mediastinal membrane
2) Stethoscope: Breathing sound (Trapped air)

Treatment
1) Observation: Heal after days
2) Aspiration
3) Chest tube/ Intercostal tube insertion (Water-seal Drainage System)
- Closed: Water meniscus rises
- Tension: Air bubble released into water
- Open: Nothing observed

Management
1) Evidence of tension (eg CV collapse)
If yes -> 2
If no -> 3
2) Immediate cannulation n tube drainage
3) Chronic lung disease?
If yes -> 4
If no -> 7
4) Lung collapse? Significant dyspnea (Difficult breathing)?
If yes -> 5
If no -> 6
5) Percutaneous needle aspiration
If yes ->8
If no -> 9
6) Inpatient observation
7) Lung collapse? Significant dyspnea (Difficult breathing)?
If yes -> 5
If no -> 8
8) Outpatient follow-up
9) Intercostal tube drainage