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Prognosis Prognosis varies among the pneumothorax classifications Recurrence rate is about 28% for PSP and 43% for SSP over a period of 5 years. Clinical Presentation Depends upon: Symptoms: Volume of air Rapidity of onset Tension within the pleural space Age and respiratory reserve Dyspnea Chest pain More severe than PSP Infectious cause of SSP may have cough, fever, chills, or fatigue! Thoracostomy tube size in SSP Small bore catheters have advantages over larger tubes Ease of insertion Patient comfort Equally efficacious in most patients in retrospective studies One possible exception to the use of small bore tubes for SSP would be patients receiving mechanical ventilation. Pigtail catheters vs large-bore chest tubes for management of secondary spontaneous pneumothoraces in adult Am J Emerg Med. Chest Tube Management Water seal device is preferable No suction due to the risk of RPE Failure of PTX to resolve => suction if it was not initially applied.
The condition can produce serious impairment of cardiopulmonary function and is fatal if not treated promptly.
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Abdel Nour, MD Moderator: Thomas Roy, MD Pulmonary and Critical Care East Tennessee State University Diagnosis and Treatment of Pneumothorax.

Mortality rate of 1-17% in patients with COPD 5% of patients with COPD died before a chest tube was placed Patients with AIDS: inpatient mortality rate of 25% and a median survival of 3 months after the pneumothorax. Epidemiology of pneumothorax in England.Gupta D, Hansell A, Nichols T, Duong T, Ayres JG, Strachan D. UK: underestimate Guidelines from the USA (ACCP-Chest 2001) overestimate the volume in a localised apical pneumothorax. Keep the chest tube until a procedure is performed to prevent recurrent SSP Pt declines preventive interventions => clamp tube 12hrs after the lung has expanded radiographically and no further air leak is detected via the chest tube. Symptoms are similar to those of mediastinal shift.mediastinal shift a shifting or moving of the tissues and organs that comprise the mediastinum (heart, great vessels, trachea, and esophagus) to one side of the chest cavity. Diminished breath sounds, absent fremitus, and hyperresonance to percussion on the affected side. The condition occurs when a severe injury to the chest causes the entrapment of air in the pleural space (tension pneumothorax). Processes that lead to asymmetric lung expansion, as might occur when anything fills the pleural space (e.g.
As the volume of air increases on the affected side, the lung collapses and the organs and tissues of the mediastinum are crowded to the opposite side of the chest.

This can produce compression of the other lung and kinking or twisting of one or more of the great blood vessels, which in turn seriously impairs blood flow to and from the heart.Symptoms of mediastinal shift include severe dyspnea, cyanosis, displacement of the trachea to one side, and distended neck veins. The rate of resorption can be markedly increased if supplemental oxygen is administered Normal rate of resorption is approximately 1.25% of the volume of the hemithorax per 24 hours.
The immediate treatment is insertion of a hollow needle or trocar into the pleural space (thoracentesis) to provide an outlet for the escape of air and fluid.
However, the rate of resorption increases six-fold if humidified 100 percent oxygen is administered! After the trapped air is released, closed chest drainage is initiated to allow for reexpansion of the lung.Mediastinal shift. As air from a pneumothorax is drawn into the chest cavity, it places pressure on the trachea, heart, and great vessels, causing them to shift from their normal anatomic positions. Alveolar and pleural tissue invasion and rupture of large subpleural cysts that are caused by tissue necrosis.

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