Traumatic Pneumothorax

This is the first of two episodes looking at pneumothoraces. In this episode we’re going to start out by taking a look at traumatic pneumothoraces.

Traumatic pneumothoraces are present in about a fifth of multiple trauma patients, so it’s not infrequent to come across them and they can obviously occur in those with isolated chest injury too. Thoracic trauma occurs in around two thirds of multi-trauma cases and is classified as the primary cause of death in a quarter of trauma patients.

The clinical assessment carries with it a fair amount of dogma, including looking for tensions with tracheal deviation, so we’ll be running through what the signs we should look for actually mean.

Then we’ll move on to a detailed discussion about investigation strategies before finally looking at the guidelines and evidence on the topic, including which we have to intervene with, which we probably shouldn’t and those in which there is much uncertainty…

Once again we’d love to hear any comments or questions either via the website or social media.

And to get your site involved in CoMITED you can email comited-trial@bristol.ac.uk

Enjoy!

Simon, Rob & James

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References

Current management of moderate to severe traumatic pneumothoraces: a survey of emergency clinicians. Avery. EMJ. 2021

Pneumothorax. McKnight. StatPearls. 2023

Tension pneumothorax – time for a re-think? Leigh-Smith. EMJ. 2005

Spontaneous Pneumothorax: A 5-year Experience. Sousa. J Clin Med Res. 2011

Clinical Presentation of Patients With Tension Pneumothorax: A Systematic Review. Derek. Annals of Surgery. 2015

Comparing complications of small-bore chest tubes to large-bore chest tubes in the setting of delayed hemothorax: a retrospective multicenter cohort study. Orlando. SJTREM. 2020

OPTICC: A multicentre trial of Occult Pneumothoraces subjected to mechanical ventilation: The final report. Am J Surg. 2021

Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostom. Laan. Injury. 2015

Pneumothorax: from definition to diagnosis and treatment. Zarogoulidis. J Thorac Dis. 2014

Management of simple and retained hemothorax: A practice management guideline from the Eastern Association for the Surgery of Trauma. Patel. Am J Surg. 2021

The small (14 Fr) percutaneous catheter (P-CAT) versus large (28-32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial. Kulvatunyou. J Trauma Acute Care Surg. 2021

Conservative Management in Traumatic Pneumothoraces: An Observational Study. Walker. Chest. 2018

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