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Sep 1
14m 28s

Episode 213: Pneumothorax

CORE EM
About this episode

We break down pneumothorax: risks, diagnosis, and management pearls.

Hosts:
Christopher Pham, MD
Brian Gilberti, MD

Download Leave a Comment Tags: Chest Trauma, Pulmonary, Trauma

Show Notes

Risk Factors for Pneumothorax

  • Secondary pneumothorax
    • Trauma: rib fractures, blunt chest trauma (as in the case).
    • Iatrogenic: central line placement, thoracentesis, pleural procedures.
  • Primary spontaneous pneumothorax
    • Young, tall, thin males (10–30 years).
    • Connective tissue disorders: Marfan, Ehlers-Danlos.
    • Underlying lung disease: COPD with bullae, interstitial lung disease, CF, TB, malignancy.
  • Technically, anyone is at risk.

Symptoms & Differential Diagnosis

  • Typical PTX presentation: Dyspnea, chest pain, pleuritic discomfort.
  • Exam clues: unilateral decreased breath sounds, focal tenderness/crepitus.
  • Red flags (suggest tension PTX):
    • JVD
    • Tracheal deviation
    • Hypotension, shock physiology
    • Severe tachycardia, hypoxia
  • Differential diagnoses:
    • Pulmonary: asthma, COPD, pneumonia, pulmonary edema (SCAPE), ILD, infections.
    • Cardiac: ACS, CHF, pericarditis.
    • PE and other acute causes of dyspnea.

Diagnostics

  • Bloodwork: limited role, except type & screen if intervention likely.
  • EKG: reasonable given chest pain/shortness of brea...
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