Episode 213: Pneumothorax

We break down pneumothorax: risks, diagnosis, and management pearls.

Hosts:
Christopher Pham, MD
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Pneumothorax.mp3 Download Leave a Comment Tags: Chest Trauma, Pulmonary, Trauma Show Notes Risk Factors for Pneumothorax

• Secondary pneumothorax
  • Trauma: rib fractures, blunt chest trauma (as in the case).
  • Iatrogenic: central line placement, thoracentesis, pleural procedures.
• Primary spontaneous pneumothorax
  • Young, tall, thin males (10–30 years).
  • Connective tissue disorders: Marfan, Ehlers-Danlos.
  • Underlying lung disease: COPD with bullae, interstitial lung disease, CF, TB, malignancy.
• Technically, anyone is at risk.

Symptoms & Differential Diagnosis

• Typical PTX presentation: Dyspnea, chest pain, pleuritic discomfort.
• Exam clues: unilateral decreased breath sounds, focal tenderness/crepitus.
• Red flags (suggest tension PTX):
  • JVD
  • Tracheal deviation
  • Hypotension, shock physiology
  • Severe tachycardia, hypoxia
• Differential diagnoses:
  • Pulmonary: asthma, COPD, pneumonia, pulmonary edema (SCAPE), ILD, infections.
  • Cardiac: ACS, CHF, pericarditis.
  • PE and other acute causes of dyspnea.

Diagnostics

• Bloodwork: limited role, except type & screen if intervention likely.
• EKG: reasonable given chest pain/shortness of brea...