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    Pneumothorax

    Pneumothorax is a topic covered in the 5-Minute Emergency Consult.

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    Emergency Central

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    Basics

    Description

    • Presence of free air in the intrapleural space
    • Spontaneous pneumothorax is due to atraumatic rupture of alveolus, bronchiole, or bleb.
    • Primary spontaneous pneumothorax (2/3 of incidences):
      • No underlying pulmonary pathology present
      • Rupture of small subpleural cyst or bleb
      • Primarily young, healthy patients (20–40 yr old) with tall, thin body habitus
      • Risk factors: Smoking, family history, Marfan syndrome, homocystinuria, thoracic endometriosis
    • Secondary spontaneous pneumothorax from underlying pulmonary pathology (see Etiology)
    • Tension pneumothorax:
      • Air continues to enter pleural space through bronchoalveolar disruption and becomes trapped via “ball-valve” mechanism.
      • Intrapleural pressure increases.
      • Venous return to right heart decreases, resulting in decrease in cardiac output.
      • Mediastinum shifts toward uninvolved side, mechanically interfering with right atrial filling.
      • Ventilation compromise and ventilation/perfusion mismatch result in hypoxemia

    Etiology

    • Idiopathic
    • Airway disease:
      • Chronic obstructive pulmonary disease (COPD)
      • Asthma
      • Cystic fibrosis
    • Infections:
      • Necrotizing bacterial pneumonia
      • TB
      • Fungal pneumonia
      • Pneumocystis carinii
    • Neoplasm
    • Interstitial lung disease:
      • Sarcoidosis
      • Idiopathic pulmonary fibrosis
      • Lymphangiomyomatosis
      • Tuberous sclerosis
      • Pneumoconioses
    • Connective tissue diseases
    • Pulmonary infarction
    • Endometriosis
    • Blunt chest trauma
    • Penetrating trauma to neck or trunk
    • Iatrogenic:
      • Central line placement
      • Other vascular access procedures

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    Citation

    Rosen, Peter, et al., editors. "Pneumothorax." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307236/all/Pneumothorax.
    Pneumothorax. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307236/all/Pneumothorax. Accessed April 25, 2019.
    Pneumothorax. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307236/all/Pneumothorax
    Pneumothorax [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307236/all/Pneumothorax.
    * Article titles in AMA citation format should be in sentence-case
    TY - ELEC T1 - Pneumothorax ID - 307236 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307236/all/Pneumothorax PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -