1- Syndrome gaseous effusion of the pleura:
– Relative immobility of the hemithorax injured
– Abolition of local vibrations
– Hypersonorité percussion
– Abolition breath sounds
2- severity of clinical signs:
– Pneumothorax compressive or undervoltage whose suggestive signs are:
* Acute respiratory failure with dyspnea, tachypnea, cyanosis and inability to speak
* The affected hemithorax is distended
* Signs of poor hemodynamic tolerance tachycardia> 120 / min; IVD or signs of low blood pressure
– Hemopneumothorax: pallor associated with tachycardia; linked to a rupture of a flange; overcome dullness of a bloat (skodisme).
3- CXR:
– Must be performed in a subject standing in deep inspiration. The PNX predominates at summits
– In case of suspicion of minimal forms -> cliché forced expiration. The forced expiration may worsen tolerance of compression PNX.
– A fluid reaction (low) is common
– Five radiological signs of severity:
* PNX compression: shift of the mediastinum (the opposite side) and flattening of the diaphragm
* Pleural Bride: it reflects a joining of the pleura with risk of rupture and bleeding
* Hydroaeric Level: hemopneumothorax
* Bilateral pneumothorax
* Anomaly of the underlying parenchyma: Any associated pathology is a severity factor
ECG
Can be changed during a PTX left with right axis deviation, decreased R-wave, T-wave inversion in precordial.
4- What to do in an emergency:
a- Primitive or spontaneous pneumothorax (PSP topic lanky young and often smoking):
* PTX minimal (<3cm or 10%) abstention and rest; smoking cessation is essential
* Medium severity PSP (complete detachment) -> evacuation of air (single exsufflation needle, pleurocathéter, chest tube)
* PSP complicated with respiratory discomfort: evacuation drain with a large emergency gauge
– Compressive pneumothorax: needle decompression table if acute asphyxia but the drain is secondarily systematic.Oxygen therapy and intravenous.
– Hemopneumothorax: imposes a double drainage: lower and upper drain drain; if bleeding persists a thoracotomy hemostasis is required.
– Bilateral pneumothorax: the water must be undertaken first of the least off side. Pleural symphysis must be systematically
* PSP relapsed (the risk of recurrence is 30 to 50%): pleural symphysis is recommended in case of second ipsilateral recurrence, contralateral recurrence or bilateral PTX.
b- Secondary pneumothorax:
* PTX secondary to respiratory disease: It imposes a chest drainage longer duration. Persistent bubbling may need the surgery
* PTX Iatrogenic: same as the PSP
* Pyopneumothorax: bronchial drainage of large caliber with local washes and antibiotics
* PTX ventilator