in reply to Axel SIU, HKNET
sorry about the delay in replying but I've only just joined this mail
thing. I too am interested in the management of spontaneous
pneumothorax. Myself and Tom Carrigan (A&E spr's) did an audit on
spontaneous pneumothorax in the A&E departments at York and Leeds
General infirmary (not published yet). We found that adherance to the
guidelines reached abuout 50% of cases, with over- and under-treatment
being problems. What was interesting was the high number of technical
failures of (correctly indicated) aspiration-more so than previously
published figures in the BMJ (1993). We suspect that the original data
claiming high success with aspiration included patients with repeated
attempts at aspiration. We suspect that using larger and stiffer
canulae may overcome some of the problems.
As for my experiences-I aspirated a complete spontaneous pneumothorax in
Preston A&E using a needle (BTS guidelines), with virtually complete
resolution. The patient was kept overnight and wandered off to the
canteen the next morning. He returned complaing of new brethlessness
and radiologically had a tension pneumothorax. I've known about two
similar cases-hence I'm not happy about any of these patients being sent
home after initial apparent successful treatment. I've often found the
procedure of needle aspiration easier with miazolam sedation iv and I've
successfully treated a 13 and 15 year old using this. There is nothing
that I could find in the literature about when to re-Xray etc and my
impresssion is that the BTS guidelines have not been validated
properly. Apparently they are being revised for next year.
hope this is of some use
Francis Andrews FFAEM
lecturer in intensive care, Liverpool
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