Pneumothorax

Pneumothorax management: are the guidelines all-encompassing for the purpose of Acute Medicine?

Pneumothorax is defined as the presence of air in the pleural space, between the lung and the chest wall. It is a significant global health problem, with considerable morbidity and healthcare costs. Best management strategy remains controversial, with significant variation in practise, both nationally and internationally. The lack of consensus is driven by the paucity of the evidence base. Current research trials, particularly those looking at ambulatory management, are making progress and may help streamline future guidelines. This review presents five case reports of patients treated with methods which are not entirely synchronous with the current British Thoracic Society (BTS) guidelines; providing guidance for acute medical physicians who are routinely presented with such cases and exploring future developments in pneumothorax management.

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Managing Pleural Disease in Acute Medicine (II): Spontaneous Pneumothorax

Spontaneous pneumothoraces occur in individuals who have not experienced antecedent thoracic trauma. Primary spontaneous pneumothorax occurs in otherwise healthy individuals with no clinically apparent lung disease, whereas secondary pneumothorax is a consequence of an underlying lung disease. This review focuses on their management in the acute medical setting. The specific issues of simple aspiration versus intercostal tube drainage, who can be discharged home safely, and when to refer to a respiratory physician are addressed. In addition, recent developments in the management of pneumothorax are presented.

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