Pneumothorax - detailed emergency medicine revision
A pneumothorax is air in the pleural space causing partial or complete lung collapse with impaired ventilation and potential haemodynamic compromise. Rapid recognition of stability and correct emergency intervention are essential.
This section summarises anatomy, classification, clinical assessment, investigations, emergency decompression (including paediatric and traumatic special points), definitive management, complications and practical equipment/checklists aligned with BTS 2023, Resuscitation Council UK and NICE NG39.
Pleural anatomy - practical points
- The visceral pleura covers the lung; the parietal pleura lines the chest wall and mediastinum and extends from approximately 3 cm above the clavicle to the 12th rib.
- The parietal pleura secretes serous fluid (~2.5 L/day); the visceral pleura absorbs it to maintain a thin lubricating film.
- Normal intrapleural pressure is negative; breach of the pleura allows air entry and lung collapse. Apical bleb rupture is the common cause in primary spontaneous pneumothorax.
Classification and epidemiology
- Primary spontaneous pneumothorax (PSP): occurs without known lung disease; typically affects tall, thin males aged 20-30 years and is associated with ruptured subpleural blebs. Smoking increases the risk.
- Secondary spontaneous pneumothorax (SSP): occurs on a background of lung disease (COPD, asthma, CF, bronchiectasis, interstitial lung disease, infection, malignancy); patients are older and more symptomatic.
- Traumatic pneumothorax: results from blunt or penetrating trauma or iatrogenic causes (central lines, thoracentesis).
- Tension pneumothorax:...