She was tachycardic at 107 but unfortunately the rest of her observations were not taken. She was otherwise fit and well, but was taking the oral contraceptive. ECG and d-dimer were normal. She was initially diagnosed as having an anxiety attack.
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1. What does the X-ray show?
- A large right sided pneumothorax
2. Who is at risk of developing this condition? And how is this condition classified?
- Spontaneous: Primary (in tall, thin people, more often men, commonly smokers. Increased risk with positive family history)
- Secondary (due to pre-existing lung disease, including COPD, Asthma, Cystic Fibrosis, Tuberculosis, Whooping cough, Cancer, Connective tissue disease and catamenial pneumothorax caused by pleural endometriosis)
- Traumatic pneumothorax (from blunt or penetrating trauma)
- Iatrogenic pneumothorax (Central lines, positive pressure ventilation)
- Tension pneumothorax
3. According to national guidelines, how should the patient be managed?
- BTS guidelines: As this patient has a primary spontaneous pneumothorax, needle aspiration would be the first line intervention, proceeding to fine bore chest drain if this fails.
4. What is the role of oxygen in this condition?
- The British Thoracic Society advocates oxygen therapy if the patient is breathless, or has sats of below 92% in air. In addition, oxygen is recommended for those patients who are admitted for observation and conservative management as oxygen therapy accelerates the clearance of the pneumothorax.