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Pneumothorax In Pediatric Patients: Management Strategies To Improve Patient Outcomes

March 2017

Abstract

The clinical presentation of pneumothorax is highly variable. Spontaneous pneumothoraces may present with subtle symptoms when a small air leak is present, but can progress to hemodynamic instability in the setting of tension physiology. The etiologies are broad and the severity can vary greatly. A trauma patient with a pneumothorax may also have the added complexity of other potentially life-threatening injuries. While there is a wealth of evidence-based guidelines for the management of pneumothoraces in the adult literature, the approach to pediatric patients is largely extrapolated from that literature without a significant evidence base. In this issue, aspects of the history and physical examination, the use of various diagnostic imaging modalities, and the range of interventions available to the emergency clinician are discussed.

Key words: pneumothorax, PTX, pneumothoraces, primary spontaneous pneumothorax, PSP, secondary pneumothorax, tension pneumothorax, tension physiology, open pneumothorax, occult pneumothorax, chest radiography, x-ray, point-of-care ultrasound, ultrasound, computed tomography, CT, thoracostomy, needle decompression, chest tube, pigtail catheter, surgical method, modified Seldinger technique, pediatric, child

Points

  • Underlying conditions and diseases that increase the risk of secondary pneumothorax include pulmonary, infectious, systemic, and iatrogenic etiologies. Recent procedures involving the neck, chest, or abdomen can lead to an iatrogenic pneumothorax.
  • For a traumatic pneumothorax, evaluate for concomitant injuries including rib fractures, pulmonary contusions, subcutaneous emphysema, and cardiac injuries.

Pearl

  • Place a chest tube before or immediately after intubation, as intubation can convert a patient to a positive-pressure physiology, leading to worsening pneumothorax.
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Last Modified: 03/27/2017
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