A case of spontaneous pneumothorax comes to you. What will be earliest t/t of choice -
Ans is 'b' ie Needle aspiration Pneumothorax : is the presence of gas in the pleural space. Types : (a) Spontaneous pheumothorax ---> is one that occurs without antecedant trauma to the thorax (i) Primary spontaneous - Occurs in the absence of an underlying lung disease (usually d/t apical plural blebs). (ii) Secondary spontaneous - d/t an underlying lung disease. (b) Traumatic pneumothorax --) results from penetrating or non penetrating injuries to the chest. (c) Tension pheumothorax Any pneumothorax in which the pressure in the pleural space is positive throughout the respiratory cycle. In this pt. its not specified the type of spontaneous pneumothorax; still let's see the t/t Treatment Primary spontaneous pneumothorax ? Initial recommended treatment is simple aspiration If the lung does not expand with aspiration, or if the pt. has a recurrent pneumothorax, thoracoscopy with stapling of blebs and pleural abrasion is indicated (100% success rate) Secondary Spontaneous pneumothorax Sec. spon. pneumothorax can occur in any lung ds but are commonly seen in COPD. Nearly all pts are t/t with tube thoracostomy and the instillation of a sclerosing agent such as doxycycline or talc. - Pts. with persitent air leak, an unexpanded lung after 3 days of tube thoracostomy, or a recurrent pneumothorax should be subjected to thoracoscpy with bleb resection and plueral abrasion. Traumatic pneumothorax Traumatic pneumothorax should be t/t with tube thoracostomy unless they are very small. If a hemopneumothorax is present, one chest tube should be placed in the superior pa of the hemithorax to evacuate the air, and another should be placed in the inferior pa of the hemithorax to remove the blood. Tension pneumothorax - It is an emergency situation. A large bore needle is inseed into the pleural space through the Second anterior intercostal space. The needle should be left in place until a thoracostomy tube is inseed. I assume that the pt. has primary spontaneous pneumothorax as there is no past history of any disease (as it is not mentioned in the question).
IPPV
Needle aspiration
ICD
Wait and watch