Traumatic

Pneumothorax
Dr F Morris
 Overview

Case scenario

Chest emergencies

Chest drain vs conservative

Chest drain insertion

Cardiothoracic advice
 A tale of two chests

1. 25M BIBA 0400hrs; MVA, driver, found at

roadside:

Sternal tenderness

2. 30M AFL player crunched in chest on live TV:

Paradoxical chest wall movement.

 Chest injuries
A Airway obstruction Aortic injury

T Tension pneumothorax Thorax injuries

O Open pneumothorax Oesophageal perforation

M Massive haemothorax Muscular diaphragmatic injury

Fistula or other
F Flail segment + contusion
tracheobronchial injury

C Cardiac tamponade Contusion to heart or lungs

 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.
 Current evidence
BTS BSP ACCP

Small + minimally
<2cm -
symptomatic

Aspiration Aspiration Chest drain

Data on traumatic pneumothorax management

are limited.
 Chest drain

Needle vs finger thoracotomy

Suture pack?

Tube size

Big - 26-28Fr

Bigger - up to 40Fr!
 Cardiothoracics

Consult for any patient with rib fractures:

intercostal n. and paravertebral blocks

ORIF / plating

Traumatic pneumothoraces

Big tubes!
 References

1. 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

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

3. 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.