Sat27November0556PM 24

A 19-year-old male presented with pleuritic chest pain which occurred suddenly while playing football. He presented to the Emergency department complaining of dyspnoea. His chest x ray is shown.

What would be the definitive treatment for this condition?

(Please select 1 option)

Low molecular weight heparin

Nebulised salbutamol

High-flow inspired oxygen

Intercostal chest drain insertion Correct

Intravenous amoxicillin + clarithromycin

Explanation

The slide shows a large left-sided tension pneumothorax.

The left hemithorax is hyperinflated with loss of lung markings peripherally. This is particularly noticeable in the left lower zone. There is also a mediastinal shift away from the midline towards the right.

This is a classical presentation of pneumothorax: young fit male (often tall) who develops chest pain and shortness of breath while exercising.

What are the alternatives presented here?

This would be an unusual presentation of PE

There is no history of wheeze to suggest bronchoconstriction

There is no consolidation on the CXR

Nor any suggestion in the history that suggests infection.

Having ruled out these alternatives you have two options that might be used to treat pneumothorax (oxygen or chest tube).

If you realise that this is a pneumothorax, the question tries to establish whether you are aware of the circumstances in which oxygen alone is adequate versus those in which chest tube insertion is necessary.

Where there is a tension pneumothorax neither oxygen alone nor needle aspiration are the definitive treatment and a chest tube must be inserted. The definitive treatment is the one that will lead to resolution of the pathology and a needle aspiration (or thoracocentesis) will not be big enough to allow the tension pneumothorax to resolve.

Answer Statistics

1

1%

2

1%

3

6%

4

94%

5

1%

Times answered: 356