Episode 213: Pneumothorax
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About this listen
We break down pneumothorax: risks, diagnosis, and management pearls.
Hosts:
Christopher Pham, MD
Brian Gilberti, MD
- 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.
- 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.
- Bloodwork: limited role, except type & screen if intervention likely.
- EKG: reasonable given chest pain/shortness of breath.
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