Decompression, Drain or not to drain...

Tension pneumothorax... every one knows how and where to decompress (https://www.youtube.com/watch?v=PblI70wkpjg - you only have to watch the first three minutes but I recommend the whole episode).

However what if it is a primary pneumothorax, measured at 3cm and no features of a tension? Fortunately the BTS are there to help: http://www.brit-thoracic.org.uk/Portals/0/Guidelines/PleuralDiseaseGuidelines/Pleural%20Guideline%202010/Pleural%20disease%202010%20pneumothorax.pdf

The Takeaway points can be summarised in the following flow chart and diagram

Another nice easy stem would be to describe the anatomical landmarks for the safety triangle:

Question...

(this should be easy after reading the above)

A skinny 24 your old presents with shortness of breath and reduced air entry on auscultation of the left chest.

1) Describe your management of this condition.

2) What features would suggest a tension pneumothorax?

3) Give the land marks of the "safe ares" for chest drain insertion, and why is it "safe"?

4) List three predisposing factors for this condition.

5) What advice would you give before discharge?