Pneumothorax

1- Syndrome gaseous effusion of the pleura:

– Relative immobility of the hemithorax injured

– Abolition of local vibrations

– Hypersonorité percussion

– Abolition breath sounds

2- severity of clinical signs:

– Pneumothorax compressive or undervoltage whose suggestive signs are:

* Acute respiratory failure with dyspnea, tachypnea, cyanosis and inability to speak

* The affected hemithorax is distended

* Signs of poor hemodynamic tolerance tachycardia> 120 / min; IVD or signs of low blood pressure

– Hemopneumothorax: pallor associated with tachycardia; linked to a rupture of a flange; overcome dullness of a bloat (skodisme).

Pneumothorax Radiography

3- CXR:

– Must be performed in a subject standing in deep inspiration. The PNX predominates at summits

– In case of suspicion of minimal forms -> cliché forced expiration. The forced expiration may worsen tolerance of compression PNX.

– A fluid reaction (low) is common

– Five radiological signs of severity:

* PNX compression: shift of the mediastinum (the opposite side) and flattening of the diaphragm

* Pleural Bride: it reflects a joining of the pleura with risk of rupture and bleeding

* Hydroaeric Level: hemopneumothorax

* Bilateral pneumothorax

* Anomaly of the underlying parenchyma: Any associated pathology is a severity factor

ECG
Can be changed during a PTX left with right axis deviation, decreased R-wave, T-wave inversion in precordial.

4- What to do in an emergency:

a- Primitive or spontaneous pneumothorax (PSP topic lanky young and often smoking):

* PTX minimal (<3cm or 10%) abstention and rest; smoking cessation is essential

* Medium severity PSP (complete detachment) -> evacuation of air (single exsufflation needle, pleurocathéter, chest tube)

* PSP complicated with respiratory discomfort: evacuation drain with a large emergency gauge

– Compressive pneumothorax: needle decompression table if acute asphyxia but the drain is secondarily systematic.Oxygen therapy and intravenous.

– Hemopneumothorax: imposes a double drainage: lower and upper drain drain; if bleeding persists a thoracotomy hemostasis is required.

– Bilateral pneumothorax: the water must be undertaken first of the least off side. Pleural symphysis must be systematically

* PSP relapsed (the risk of recurrence is 30 to 50%): pleural symphysis is recommended in case of second ipsilateral recurrence, contralateral recurrence or bilateral PTX.

b- Secondary pneumothorax:

* PTX secondary to respiratory disease: It imposes a chest drainage longer duration. Persistent bubbling may need the surgery

* PTX Iatrogenic: same as the PSP

* Pyopneumothorax: bronchial drainage of large caliber with local washes and antibiotics

* PTX ventilator

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Editor-in-chief of the Medical Actu website; general practitioner graduated from the Faculty of Medicine of Algiers in 2005 currently practicing as a liberal.

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