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Types

1. Simple: air in pleural space
2. Tension: one-way valve effect
3. Open: Sucking chest wound

Causes

1. Spontaneous: rupture of blebs - asthmatics, skinny lanky
2. Trauma
3. Iatrogenic 

Recognition

1. Conscious
   • Tachycardia, tachypnoea, decreased sats
   • Tracheal deviation, hyper-resonance
   • Surgical emphysema
2. Unconcious / ventilated
   • Sudden hypoxia
   • Sudden increase in ventilatory pressures
   • Sudden hypotension or rising CVP
   • New arrythmia

Management

1. Early recognition (esp tension)
2. 100% O2
3. Tension - needle decompression (2ICS)
4. Chest drain 

Pleurodesis

• Performed endoscopically (VATS - video assisted thoracoscopic surgery)
• Chemical
• Physical - by abrasive pads: used for younger patients as chemical pleurodesis carries theoretical risk of increasing malignancy

Indications for Thoracotomy in Haemopneumothorax
(Persistent bleeding - usually from chest wall ~80%)

• Loss of >1500mls immediately into drain
• Loss of >200mls/hr for 2-4 hours
• Requirement for persistent blood transfusion