Pneumothorax and Barotrauma

Pneumothorax and Barotrauma is a topic covered in the Pocket ICU Management.

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First Things First (assess for & treat the following)

Recognize pressure-related injury. Alveolar rupture causes gas to dissect along the bronchovascular bundle, causing:
- Pneumothorax/tension pneumothorax
- Bronchopleural fistula
- Lung & subpleural air cysts
- Pulmonary interstitial emphysema
- Pneumomediastinum
- Pneumoperitoneum/pneumoretroperitoneum
- Subcutaneous emphysema
- Systemic gas embolism
Is urgent intervention needed?
- Cardiac arrest (pulseless electrical activity)
- Shock (BP < 80 mmHg; pulse >120)
- Respiratory compromise (hypoxemia/hypercapnia)
  - Inability to ventilate; increased plateau (static pressure)
Radiographic abnormality only?
- Careful monitoring required
- Pneumomediastinum & subcutaneous emphysema have risk of pneumothorax.
- Pneumothorax in mechanically ventilated patient requires a chest tube.

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First Things First (assess for & treat the following)

Recognize pressure-related injury. Alveolar rupture causes gas to dissect along the bronchovascular bundle, causing:
- Pneumothorax/tension pneumothorax
- Bronchopleural fistula
- Lung & subpleural air cysts
- Pulmonary interstitial emphysema
- Pneumomediastinum
- Pneumoperitoneum/pneumoretroperitoneum
- Subcutaneous emphysema
- Systemic gas embolism
Is urgent intervention needed?
- Cardiac arrest (pulseless electrical activity)
- Shock (BP < 80 mmHg; pulse >120)
- Respiratory compromise (hypoxemia/hypercapnia)
  - Inability to ventilate; increased plateau (static pressure)
Radiographic abnormality only?
- Careful monitoring required
- Pneumomediastinum & subcutaneous emphysema have risk of pneumothorax.
- Pneumothorax in mechanically ventilated patient requires a chest tube.

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