Pneumothorax
Patient Presentation:
L.W., a 22 year old male, presented to the ED with chest pain and shortness of breath. Health history includes asthma and an appendectomy 3 years ago. Vital signs include BP 129/62, HR 128, RR 36, T 36.9, SpO2 84% on room air.
Differential Diagnosis:
Pneumothorax, pulmonary embolism
Diagnosis:
Oxygen was applied to increase oxygen saturation and a chest x-ray and CT were ordered. Labs were obtained including CMP, CBC, PT/PTT/INR, and D-dimer.
X-ray showed the right lung was collapsed and the patient was diagnosed with a pneumothorax. A chest tube was immediately inserted and connected to continuous suction. A small amount of serous fluid was also drained from the chest tube and a sample was sent for culturing in the lab. The CT confirmed diagnosis of the pneumothorax and showed no pulmonary embolism. All labs were within normal range for this patient.
Treatment/Outcome:
L.W. was admitted to an inpatient unit for observation until the lung re-expanded. After several days the pneumothorax did not fully resolve so talc pleurodesis was completed to help maintain inflation of the lung. Pain medications were started and the patient was educated on the importance of use of the incentive spirometer, coughing and deep breathing to prevent a reoccurring pneumothorax.