Spontaneous pneumothorax - Revision history

Jonrako at 18:52, 28 July 2021

2021-07-28T18:52:36Z

← Revisión anterior		Revisión del 18:52 28 jul 2021
Línea 37:		Línea 37:

	==Evaluation==		==Evaluation==
			[[File:PneumothoraxCT.jpg\|thumb]]
	{{Pneumothorax diagnosis}}		{{Pneumothorax diagnosis}}
	{{Lung ultrasound pneumothorax}}		{{Lung ultrasound pneumothorax}}
	{{Estimating pneumothorax size}}		{{Estimating pneumothorax size}}

	~~[[File:PneumothoraxCT.jpg\|thumb]]~~

	==Management<ref name="BTC">"Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010" British Thoracic Society Guidelines. Thorax 2010;65:ii18-ii31 doi:10.1136/thx.2010.136986 [https://www.brit-thoracic.org.uk/Portals/0/Guidelines/PleuralDiseaseGuidelines/Pleural%20Guideline%202010/Pleural%20disease%202010%20pneumothorax.pdf PDF]</ref>==		==Management<ref name="BTC">"Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010" British Thoracic Society Guidelines. Thorax 2010;65:ii18-ii31 doi:10.1136/thx.2010.136986 [https://www.brit-thoracic.org.uk/Portals/0/Guidelines/PleuralDiseaseGuidelines/Pleural%20Guideline%202010/Pleural%20disease%202010%20pneumothorax.pdf PDF]</ref>==

Jonrako: /* Evaluation */

2021-07-28T18:51:19Z

Evaluation

← Revisión anterior		Revisión del 18:51 28 jul 2021
Línea 38:		Línea 38:
	==Evaluation==		==Evaluation==
	{{Pneumothorax diagnosis}}		{{Pneumothorax diagnosis}}
	~~[[File:PneumothoraxCT.jpg\|thumb]]~~
	{{Lung ultrasound pneumothorax}}		{{Lung ultrasound pneumothorax}}
	{{Estimating pneumothorax size}}		{{Estimating pneumothorax size}}

			[[File:PneumothoraxCT.jpg\|thumb]]

	==Management<ref name="BTC">"Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010" British Thoracic Society Guidelines. Thorax 2010;65:ii18-ii31 doi:10.1136/thx.2010.136986 [https://www.brit-thoracic.org.uk/Portals/0/Guidelines/PleuralDiseaseGuidelines/Pleural%20Guideline%202010/Pleural%20disease%202010%20pneumothorax.pdf PDF]</ref>==		==Management<ref name="BTC">"Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010" British Thoracic Society Guidelines. Thorax 2010;65:ii18-ii31 doi:10.1136/thx.2010.136986 [https://www.brit-thoracic.org.uk/Portals/0/Guidelines/PleuralDiseaseGuidelines/Pleural%20Guideline%202010/Pleural%20disease%202010%20pneumothorax.pdf PDF]</ref>==

Jonrako at 18:49, 28 July 2021

2021-07-28T18:49:01Z

← Revisión anterior		Revisión del 18:49 28 jul 2021
Línea 38:		Línea 38:
	==Evaluation==		==Evaluation==
	{{Pneumothorax diagnosis}}		{{Pneumothorax diagnosis}}
			[[File:PneumothoraxCT.jpg\|thumb]]
	{{Lung ultrasound pneumothorax}}		{{Lung ultrasound pneumothorax}}
	{{Estimating pneumothorax size}}		{{Estimating pneumothorax size}}

Rossdonaldson1: /* Management"Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010" British Thoracic Society Guidelines. Thorax 2010;65:ii18-ii31 doi:10.1136/thx.2010.136986 PDF */

2020-03-21T22:20:25Z

Management"Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010" British Thoracic Society Guidelines. Thorax 2010;65:ii18-ii31 doi:10.1136/thx.2010.136986 PDF

← Revisión anterior		Revisión del 22:20 21 mar 2020
Línea 42:		Línea 42:

	==Management<ref name="BTC">"Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010" British Thoracic Society Guidelines. Thorax 2010;65:ii18-ii31 doi:10.1136/thx.2010.136986 [https://www.brit-thoracic.org.uk/Portals/0/Guidelines/PleuralDiseaseGuidelines/Pleural%20Guideline%202010/Pleural%20disease%202010%20pneumothorax.pdf PDF]</ref>==		==Management<ref name="BTC">"Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010" British Thoracic Society Guidelines. Thorax 2010;65:ii18-ii31 doi:10.1136/thx.2010.136986 [https://www.brit-thoracic.org.uk/Portals/0/Guidelines/PleuralDiseaseGuidelines/Pleural%20Guideline%202010/Pleural%20disease%202010%20pneumothorax.pdf PDF]</ref>==
			[[File:Fxsvhxkkv6h31.png\|thumb\|Rearanged British Thoracic Society (BTS) guidelines for spontaneous pneumothorax]]
	''[[Supplemental oxygen]] ([[non-rebreather mask]]) initially for all''		''[[Supplemental oxygen]] ([[non-rebreather mask]]) initially for all''

Rossdonaldson1: /* First Episode */

2020-02-10T18:29:49Z

First Episode

← Revisión anterior		Revisión del 18:29 10 feb 2020
Línea 58:		Línea 58:
	[[File:BTS Pneumothorax.png\|thumb]]		[[File:BTS Pneumothorax.png\|thumb]]
	*British Thoracic Society Protocol<ref>Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010 https://thorax.bmj.com/content/65/Suppl_2/ii18</ref>		*British Thoracic Society Protocol<ref>Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010 https://thorax.bmj.com/content/65/Suppl_2/ii18</ref>
	*2020 study supports conservative therapy vs chest tube. <ref>~~Simon G.A. et. al~~ Conservative versus ~~Interventional Treatment~~ for ~~Spontaneous Pneumothorax N Engl J Med 2020; 382:405-415 https://www.nejm.org/doi/full/10.1056/NEJMoa1910775~~</ref> however there are issues with study including “significant drop out rate, the relatively large number of protocol violations, the large inferiority margins and the short intervention time.”<ref>https://www.stemlynsblog.org/jc-conservative-management-of-pneumothoraces/</ref>		*2020 study supports conservative therapy vs chest tube. <ref>[[EBQ:Conservative versus interventional treatment for spontaneous pneumothorax]]</ref> however there are issues with study including “significant drop out rate, the relatively large number of protocol violations, the large inferiority margins and the short intervention time.”<ref>https://www.stemlynsblog.org/jc-conservative-management-of-pneumothoraces/</ref>
	** Inclusion criteria		** Inclusion criteria
	***14 to 50 years of age		***14 to 50 years of age

Hoxbox: /* First Episode */

2020-02-10T14:14:38Z

First Episode

← Revisión anterior		Revisión del 14:14 10 feb 2020
Línea 56:		Línea 56:
	**Aspiration (see below)		**Aspiration (see below)
	***If fail, admit with [[chest tube]] to suction for thoracoscopy (VATS)^		***If fail, admit with [[chest tube]] to suction for thoracoscopy (VATS)^
			[[File:BTS Pneumothorax.png\|thumb]]
			*British Thoracic Society Protocol<ref>Management of spontaneous pneumothorax: British Thoracic Society pleural disease guideline 2010 https://thorax.bmj.com/content/65/Suppl_2/ii18</ref>
	*2020 study supports conservative therapy vs chest tube. <ref>Simon G.A. et. al Conservative versus Interventional Treatment for Spontaneous Pneumothorax N Engl J Med 2020; 382:405-415 https://www.nejm.org/doi/full/10.1056/NEJMoa1910775</ref> however there are issues with study including “significant drop out rate, the relatively large number of protocol violations, the large inferiority margins and the short intervention time.”<ref>https://www.stemlynsblog.org/jc-conservative-management-of-pneumothoraces/</ref>		*2020 study supports conservative therapy vs chest tube. <ref>Simon G.A. et. al Conservative versus Interventional Treatment for Spontaneous Pneumothorax N Engl J Med 2020; 382:405-415 https://www.nejm.org/doi/full/10.1056/NEJMoa1910775</ref> however there are issues with study including “significant drop out rate, the relatively large number of protocol violations, the large inferiority margins and the short intervention time.”<ref>https://www.stemlynsblog.org/jc-conservative-management-of-pneumothoraces/</ref>
	** Inclusion criteria		** Inclusion criteria

Hoxbox: /* First Episode */

2020-02-10T11:48:03Z

First Episode

← Revisión anterior		Revisión del 11:48 10 feb 2020
Línea 56:		Línea 56:
	**Aspiration (see below)		**Aspiration (see below)
	***If fail, admit with [[chest tube]] to suction for thoracoscopy (VATS)^		***If fail, admit with [[chest tube]] to suction for thoracoscopy (VATS)^
	*2020 study ~~found no difference in~~ conservative therapy vs chest tube. <ref>Simon G.A. et. al Conservative versus Interventional Treatment for Spontaneous Pneumothorax N Engl J Med 2020; 382:405-415 https://www.nejm.org/doi/full/10.1056/NEJMoa1910775</ref>		*2020 study supports conservative therapy vs chest tube. <ref>Simon G.A. et. al Conservative versus Interventional Treatment for Spontaneous Pneumothorax N Engl J Med 2020; 382:405-415 https://www.nejm.org/doi/full/10.1056/NEJMoa1910775</ref> however there are issues with study including “significant drop out rate, the relatively large number of protocol violations, the large inferiority margins and the short intervention time.”<ref>https://www.stemlynsblog.org/jc-conservative-management-of-pneumothoraces/</ref>
	** Inclusion criteria		** Inclusion criteria
	***14 to 50 years of age		***14 to 50 years of age

Hoxbox: /* First Episode */

2020-02-06T14:44:50Z

First Episode

@@ Línea 56: / Línea 56: @@
 **Aspiration (see below)
 ***If fail, admit with [[chest tube]] to suction for thoracoscopy (VATS)^
 ====Recurrent OR Hemopneumothorax====

ClaireLewis at 15:04, 12 October 2019

2019-10-12T15:04:56Z

← Revisión anterior		Revisión del 15:04 12 oct 2019
Línea 1:		Línea 1:
	''"Spontaneous" essentially refers to all ~~pneumothoraxes~~ of "non-traumatic" etiologies''		''"Spontaneous" essentially refers to all pneumothoraces of "non-traumatic" etiologies''

	==Background==		==Background==
	*Primary Pneumothorax		*Primary Pneumothorax
	**Marfan's, Ehlers-Danlos, alpha-1-antitrypsin deficiency, homocystinuria		**[[marfan syndrome\|Marfan's]], [[Ehlers-Danlos syndrome\|Ehlers-Danlos]], alpha-1-antitrypsin deficiency, homocystinuria
	**No underlying pulmonary disease		**No underlying pulmonary disease
	*Secondary Pneumothorax		*Secondary Pneumothorax
	**With underlying pulmonary disease		**With underlying pulmonary disease
	***bullae/blebs, emphysema, cystic fibrosis, PJP pneumonia, lung abscess, tuberculosis, neoplasm, catamenial		***bullae/blebs, [[COPD\|emphysema]], [[cystic fibrosis]], [[PCP PNA\|PJP pneumonia]], [[lung abscess]], [[tuberculosis]], neoplasm, catamenial
	**Worse prognosis		**Worse prognosis

Línea 14:		Línea 14:
	*[[COPD]]		*[[COPD]]
	*[[Asthma]]		*[[Asthma]]
	*Cystic fibrosis		*[[Cystic fibrosis]]
	*Necrotizing pneumonia		*Necrotizing [[pneumonia]]
	*Lung abscess		*[[Lung abscess]]
	*[[PCP]] ~~pneumonia~~		*[[PCP pneumonia]]
	*[[TB]]		*[[TB]]
	*Neoplasm		*Neoplasm
	*Interstitial lung disease		*[[Interstitial lung disease]]
	*Connective tissue disease		*[[Connective tissue disease]]
	*Pulmonary infarct		*Pulmonary infarct
	*[[Catamenial pneumothorax]]		*[[Catamenial pneumothorax]]
Línea 28:		Línea 28:
	*Sudden onset pleuritic [[chest pain]] evolving to dull constant ache over days		*Sudden onset pleuritic [[chest pain]] evolving to dull constant ache over days
	*Most often occurs at rest, not during exertion		*Most often occurs at rest, not during exertion
	*Tachypnea, hypoxemia, increased work of breathing		*[[Tachypnea]], [[hypoxemia]], increased work of breathing
	*Reduced ipsilateral lung excursion		*Reduced ipsilateral lung excursion
	*[[Hypotension]]→ tension pneumothorax		*[[Hypotension]]→ [[tension pneumothorax]]

	==Differential Diagnosis==		==Differential Diagnosis==
Línea 45:		Línea 45:

	===Unstable===		===Unstable===
	*[[Needle ~~decompresion~~]] followed by [[chest tube]] insertion		*[[Needle decompression]] followed by [[chest tube]] insertion
	* ATLS guidelines recommend 5cm angiocath at 2nd intercostal space at the mid-clavicular line		* ATLS guidelines recommend 5cm angiocath at 2nd intercostal space at the mid-clavicular line
	* More recent evidence shows higher success rates with 4th/5th intercostal space at the anterior or mid-axillary line		* More recent evidence shows higher success rates with 4th/5th intercostal space at the anterior or mid-axillary line

Rossdonaldson1: /* Evaluation */

2019-07-20T12:48:43Z

Evaluation

← Revisión anterior		Revisión del 12:48 20 jul 2019
Línea 38:		Línea 38:
	==Evaluation==		==Evaluation==
	{{Pneumothorax diagnosis}}		{{Pneumothorax diagnosis}}
			{{Lung ultrasound pneumothorax}}
	{{Estimating pneumothorax size}}		{{Estimating pneumothorax size}}