Pediatric emergency medicine trisk 4082 4082
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Tension pneumothorax is a clinical diagnosis and does not require a
radiograph for confirmation if there is hemodynamic compromise.
Exercise caution in sedating patients with pneumothoraces or
converting them to positive pressure ventilation since their
hemodynamic status can be tenuous.
Children with even small pneumothoraces may require admission for
observation.
Current Evidence
A pneumothorax is a collection of air in the pleural space. It can occur for shortor long-term duration and can be static or accumulate progressively. Because
atmospheric pressure is greater than intrapleural pressure, any mechanism that
allows even momentary communication between the atmosphere outside the chest
wall or within the tracheobronchial tree can result in a rapid shift of air into the
pleural space. A pneumothorax may occur spontaneously, or it may be the result
of trauma or a therapeutic intervention. Children with no known predisposing
pulmonary conditions are diagnosed as having a primary spontaneous
pneumothorax. Secondary spontaneous pneumothoraces occur in patients with
underlying diseases such as asthma, cystic fibrosis, or structural abnormalities
such as congenital blebs, pneumatoceles, or congenital pulmonary airway
malformations (CPAMs).
Primary spontaneous pneumothoraces are thought to be the result of sudden
increases in transpulmonary pressure resulting in alveolar rupture. Ruptured
alveoli coalesce into blebs, which usually occur apically and can rupture into the
pleural space. Varying amounts of entering air can lead to a small pneumothorax
or complete collapse of the involved lung (Fig. 124.5 ). Increased intrathoracic
pressure associated with the Valsalva maneuver or forceful inhalation has been
associated with spontaneous pneumothorax but there may be no history of any
abnormal respirations. Genetic predisposition seems to play a role in spontaneous.
Secondary spontaneous pneumothoraces often result from different
pathophysiology; these may involve a defect in the visceral pleura caused by
infection, inflammation, connective tissue disorders, or space-occupying lesions.
