-- ABCs: stable vs unstable (tension physiology) - page thoracic surgery, consider needle decompression
-- HPI Intake: *** dyspnea, chest pain, prev PTX, smoking, h/o COPD, other primary lung dx
-- Can't Miss: tension PTX
-- Admission Orders: *** telemetry, continuous pule ox
-- Initial Treatment to Consider: oxygen, pain management, avoid NIPPV
-- History: *** prev PTX, smoking, emphysema, M>F, height, recent thoracic procedure
-- Clinical: *** hypoxia, hypotension, chest pain, dyspnea
-- Exam: *** ipsilateral absence of breath sounds, hyper-resonant percussion, distended neck veins
-- Data: *** CXR
-- Etiology/DDx: *** spontaneous (primary vs secondary to lung dx like emphysema), traumatic, iatrogenic (CVC, intubation, barotrauma, bronch, thoracentesis)
The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.
-- Chest tube vs conservative management
-- O2 with goal *** >92-94%
-- Set chest tube to *** water seal,
-- CXR daily and after changes in settings
-- Pleurodesis in refractory cases
Chest tube placed on *** by *** is currently set to *** (suction, water seal / gravity, clamped), with/without appropriate tidaling, with/without air leak ***
PDF coming soon!
A pneumothorax can either be treated conservatively (watch and wait) if the air space is small, the patient is asymptomatic, and is otherwise healthy. Otherwise, a patient will need to have the air drained via a chest tube. In emergency situations, including tension pneumothorax, a needle decompression should be attempted at bedside as a bridge to a chest tube. In general, avoid NIPPV.