NBME 6 Question - Pneumothorax

[anumama]

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Hey Guys,

Hope everyones studying is going well. I was reviewing Respiratory path and remembered a question on NBME 6 regarding it... basically (not to breach copyright or whatever) it was a tall, skinny guy who had acute onset of dypsnea; PE: tympany to percussion, absent breath sounds; CXR: white visceral pleural line with absence of vessel markings next to it.

So I got that it was a spontaneous pneumothorax; however the question was asking about management. I narrowed it down to intubation/mechanical ventilation and needle aspiration. I ended up choosing needle aspiration, but according to Goljan RR thats for a tension pneumothorax. So would the intubation/mechnical ventilation be the right answer??

 

[hartbot]

seems right.

With spontaneous pneumo, youre going to lose the negative pressure in the chest cavity so I think the two things you mentioned above use positive pressure and would allow this patient to get ventilation in his lungs

 

[usmletoo]

http://www.pulmonaryreviews.com/jan00/pr_jan00_spontaneouspneu.html

 

[illixir]

chest tube wasn't an option.

 

[anumama]

well, looks like based on wikipedia (http://en.wikipedia.org/wiki/Pneumothorax) the first step in management is needle aspiration. the chest tube would be second step and would only be required if it was a large pneumothorax.