View source for Traumatic pneumothorax

==Background==
*Present in 25% of patients with [[chest trauma]]

===Types===
#Open
#*Communication between pleural space and atmospheric pressure (sucking chest wound)
#Closed
#Occult
#*Positive pressure ventilation (e.g. [[intubation]]) can convert an occult pneumothorax to a [[tension pneumothorax]]

==Clinical Features==
*[[Rib fracture]] and penetrating trauma most common causes
*Isolated pneumothorax does not cause severe symptoms until >40% of hemithorax is occupied

==Differential Diagnosis==
{{Pneumothorax types}}
{{Thoracic trauma DDX}}

==Evaluation==
*Occult pneumothorax after a stab wound may be delayed for up to 6 hours
**If patient decompensates, obtain repeat imaging
{{Pneumothorax diagnosis}}
{{Lung ultrasound pneumothorax}}
{{Estimating pneumothorax size}}

==Management==
''[[Supplemental oxygen]] with [[non-rebreather]] for all''
===[[Tension pneumothorax]]===
*Immediate [[needle thoracostomy]] followed by [[chest tube]]

===Open pneumothorax===
*Cover wound with three-sided dressing
**Make sure to avoid complete occlusion (may convert injury to a tension pneumothorax)

===Closed traumatic pneumothorax===
*[[Tube thoracostomy]] indicated if:
**Cannot be observed closely
**Requires intubation
**Will be transported by air or over a long distance
*Observation if:
**''Very'' small AND does not require mechanical ventilation
**Unchanged on repeat [[CXR]] in 6 hours
*Decision to intubate
**Intubation can lead to positive pressure which may worsen a stable traumatic pneumothorax
**If patient stable, preferable to just perform [[Thoracostomy|thoracostomy]]
**If GCS < 8 or patient having difficulty, they should be intubated

{{Chest tube size table}}

==Disposition==
Admit

{{Flying instructions after pneumothorax}}

==Complications==
*[[Reexpansion pulmonary edema]]

==See Also==
*[[Pneumothorax (main)]]
*[[Thoracic Trauma]]
*[[Hemothorax]]

==References==
<references/>

[[Category:Pulmonary]]
[[Category:Trauma]]