pneumothorax management

per BTS 2023 guidelines
see also Chest and lung injury

framework

  • 1o or 2o?
    • secondary pneumothorax patients are not going home that day
    • age >50 with smoking history = treat as secondary
  • symptomatic?

Spontaneous (primary)

  • if asymptomatic → OP f/up in 2-4 days
  • risk strat - how compromised are they
  • high risk and safe to intervene:
    • chest drain and admit
  • low risk and safe to intervene:
    • needle aspiration
      • good success rates comparable to chest drain!
      • only for 1o pneumothorax

high risk characteristics:

  • tension (duh)
  • hypoxia
  • bilateral pneumothorax
  • underlying lung disease
  • age >50 with sig smoking history
  • haemopneumothorax

secondary pneumothorax

  • inpatient observation period even if asymptomatic

needle aspiration of air

Headline
Indication
Contraindication
Kit Lidocaine
16-18G cannula
3 way tap, 50ml syringe
Sterile gloves + gown + sterile drapes
Technique/landmark Landmark: 2nd ICS midclavicular line OR safe triangle
Ongoing management - aspirate until patient coughs/discomfort
- f/up 2-4 weeks → if no resolution then chest drain

https://www.rcemlearning.co.uk/reference/spontaneous-pneumothorax/
Demo (from 12 years ago...): https://www.youtube.com/watch?v=j_UGBS-Kp2I

discharge advice

  • avoid air travel until 1/52 after full radiological resolution
  • permanent ban diving
  • stop smoking

#respiratory

https://www.brit-thoracic.org.uk/quality-improvement/guidelines/pleural-disease/
https://www.rcemlearning.co.uk/reference/spontaneous-pneumothorax/

rcem-learning-pneumothorax pathway.jpg