Name: Ahern: EES: Video 04-03: Pneumothorax

Description: Ahern: EES: Video 04-03: Pneumothorax

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Upload Date: 2022-02-27T00:00:00.0000000

Transcript: Language: EN.
Segment:0 .
If it's a straightforward asymptomatic pneumothorax in a previously healthy person, then we usually use the rule of three. One third to two thirds. If there is more than one third of the lung collapsed-- in other words, on a plain chest film, if one third of the space of that thorax is air-containing as against lung-containing, you put in the tube.
Or any more than that. However, there are other exceptions. One is the patient with that one third is symptomatic. Then you put in the tube. If you've got two x-rays some time apart and it's increased, you put in the tube. If the patient's got obstructed airways disease, emphysema, asthma, you know that the pressure on expiration is increased.
And it's going to increase the size of the pneumothorax. As the patient breathes in, he's going to be pushing, so it's going to push more air into that space. So you put in the chest tube if somebody's got that, even though it might not be one third, because it's going to increase. Finally, if a patient is going to have a general anesthetic after his trauma that's produced the pneumothorax, you put in the tube before you give the anesthetic, because the patient is going to be positively pressure-ventilated.
And that's going to increase the size of the pneumothorax. Very interesting. How do you measure the one third on the chest x-rays? You just eyeball it. Just eyeball it. Because the references have a lot of complex formulas for working out whether you put a tube in or not. And sometimes it's related to which route posterior does it come down to.
Sometimes the route isn't the level that you've got. Among other things, you probably should put in the traumatic ones if it's a hemopneumothorax. You're better putting in a tube.

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