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Hey all. Hope your studying's going well.

I have two questions that I've been having trouble with.

1) Why is it that we immediately start with a chest tube in spontaneous pneumothorax, instead of first performing needle decompression as is the case in tension pneumothorax?
2) At what level do we place the chest tube in spontaneous pneumothorax? I've heard of people say it's at the 5th intercostal. I always thought it should be at the 2nd intercostal.

So yeah. I'm really confused.
Any input/thoughts appreciated!
 

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The difference between tension pneumothorax and simple pneumothorax is that in tension pneumothorax the pressure has developed high enough to cause mediastinal shift. In doing so it obstructs superior vena cava (SVC). This leads to congestion of blood especially in head and decreased CO. Immediate needle decompression is required to relieve this pressure and relieve the obstruction of SVC.
The same does not occur in a simple/spontaneous pneumothorax. No pressure is generated. The main concern is decreased oxygen exchange or the B in ABC. That is why you would intubate such a patient.

As far as the location is concerned ... I did not find a definative source but think that 5th ICS is used in mixed and 2nd ICS for pure pneumo. I could be wrong on the positioning.
 
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