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Pneumothorax & Pleural Effusion

  1. Causes:
    1. Often spontaneous Q (especially in tall young thin men) due to rupture of a subpleural bulla.
    2. Asthma;                         
    3. Emphysema        
    4. TB;                        
    5. Staphylococcal pneumonia      
    6. Lung abscess;                  
    7. Carcinoma;
    8. Cystic fibrosis;                        
    9. Trauma
    10. Connective tissue disorders (Marfan's syndrome, Ehlers-Danlos syndrome),
  2. Primary Spontaneous pneumothorax Features are: 
    1. No clinical evidence of pre existing lung disease                
    2. Rupture of apical subpleural blebs
    3. Positive family history                                     
    4. History of smoking
    5. Tall and thin individual                                       
    6. Young adults (10 to 30 years of age)
    7. Male gender
  3. Clinical features Symptoms:  
    1. There may be no symptoms Q (especially if fit young and small pneumothorax) or there may be sudden onset of dyspnoea Q and/or pleuritic chest pain Q.
    2. Patients with asthma or COPD may present with a sudden deterioration
    3. Mechanically ventilated patients may present with hypoxia or an increase in ventilation pressures.
  4. Sign:  
    1. Decreased chest expansion on same side         
    2. Trachea shifted to other side
    3. Reduce breath sound, VR, VF on same side               
    4. Hyperresonant on percussion on same side.
  5. Managing a tension pneumothorax
    Put drainage tube in 2nd intercostal space at midclavicular line.

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