98. Under Pressure- Approach to Pneumothorax

Pneumothorax occurs when the integrity of the pleural cavity is compromised, allowing air to enter and disrupt the negative intrapleural pressure required for lung expansion. This condition manifests through various mechanisms, including traumatic injuries, iatrogenic procedures, or spontaneous events linked to underlying lung diseases like COPD or connective tissue disorders. Diagnosis relies on clinical assessment—often revealing hyper-resonance and decreased breath sounds—and imaging via chest X-ray or CT scans. Management strategies prioritize hemodynamic stability, utilizing emergency needle decompression for tension pneumothorax. Stable cases are treated with supplemental oxygen to accelerate air reabsorption, while persistent or large pneumothoraces necessitate chest tube insertion. Prophylactic interventions, such as chemical or mechanical pleurodesis, are reserved for recurrent cases, while specific presentations like catamenial pneumothorax require targeted clinical considerations.