RESPIRATORY

PNEUMOTHORAX

Introduction

5 min

Introduce yourself and the group

Provide rationale for the session and relevance to clinical practice

Outline learning objectives:

Be able to take a focussed history from a patient presenting with possible pneumothorax and consider appropriate differential diagnoses
Suggest and interpret results of relevant investigations for suspected pneumothorax
Understand the initial management of a patient with pneumothorax

Explain structure of session

Total time:

45 min

Number of students:

1-5

Grade of students:

3rd to 5th year medical students

Created by:

Dr Kit Tigwell

Uploaded:

13th September 2019

Last updated:

13th September 2019

Resources needed for this session:

Pen, paper, whiteboard or flipchart paper if possible

Students can scan the QR code opposite to view all investigation results on their phone as you work through the session.

Resources linked to this session:

None

Activity 1: History Taking and Examination

10 min

Ask student(s) to take a focused history from the patient, to include past medical history, drug history, family history and social history. This can be observed if capacity of tutors allows. If a stable patient with relevant clinical signs is available ask student(s) to examine the patient.

Activity 2: Diagnostic Reasoning

5 min

Ask the student to summarise the key findings of the case. Feedback on history taking style and presentation (max 1 minute).

Discussion points:

What differential diagnoses have you considered and why are these less likely?
What initial investigations would be useful and what are you expecting them to show?

Activity 3: Pathophysiology

5 min

Recap basic pathophysiology with the student(s). Using a whiteboard or flip chart paper if possible, construct a mind-map covering the following points:

How can pneumothorax be classified?
What are the causes of each type of pneumothorax?
How would you clinically assess the severity of a pneumothorax and, accordingly, what would be your initial management?

Activity 4: Basic Radiology Interpretation

5 min

Allow the student(s) to view the patient’s chest x-ray. If none is available, use the examples below. Ask the students to systematically interpret the x-rays in turn.

Example 1:

What is the most obvious abnormality?
How would you expect the patient to appear clinically?

Example 2:

What is the most obvious abnormality?
How does this differ to the example above?
How would you expect the patient to appear clinically?

Activity 5: Further Management

10 min

Ask the students to find some relevant guidelines on the management of pneumothorax (e.g. BTS Pneumothorax 2010 accessed via the QR code opposite). Allow them to consider or discuss amongst themselves how best the patient they have seen should be managed. Some prompts for discussion:

Does this patient need a pleural procedure? If so, what kind?
Could this patient be discharged? If so, how should they be followed up?
What advice should be given to this patient?

Activity 6: Procedures

10 min

If the patient goes on to have a pleural procedure e.g. pleural aspiration or chest drain insertion, ask the student(s) to complete the following tasks:

Find the local LocSSIPs for pleural procedures. Work through the questions with reference to the patient they have seen. The QR code opposite links to an example LocSSIP.
Find and complete the relevant sections of a mock consent form with the indication and risks for the procedure. Practice taking consent from a each other if possible. NB. Medical students should not take consent from the patient - this should be done by the qualified professional performing the procedure.