Spontaneous Pneumothorax

OMG, I “kena” attack again for this spontaneous pneumothorax thingy!!

The 1st admission was way long ago in 2007, according to my blog post.. lol

Read here & here

Let me tell the story again this time..

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On 3rd june 2014, after my presentation, I went back to work in Red Zone A&E HSA JB..

Actually I started to feel “weird” before & during my presentation.. But I ignored it..

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So after presentation, I felt more uncomfortable.. Asked my friend to examine, was told to be “normal”

Then I checked my SPO2 & pulse rate.. heart rate was 105-110.. I was shocked!

I never had my pulse rate more than 80 and even exercise also seldom go over 100!!

Started to feel uneasy, asked another colleague to examine again.. this time he said “reduced air entry left side”

I went to take X-ray..

It came out to be a massive pneumothorax!

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I was shocked after looking it! In my mind ” this is red zone case & I need a chest tube in STAT!”

My colleague saw & pressed bell for 3 times and I was in the red zone in next 10 seconds, chest tube was put in after 10 minutes..

Then I was sent to 1st class ward, told to connect to low-pressure suction to aid recovery..

What’s worse? The low-pressure suction wasn’t working properly in 1st class so they transferred me to cardiothoracic ward for close observation, KIV for VATS or open surgery!

This is not even worse! Cardiothoracic (CTC) surgeon saw my chest tube and said my chest tube was small and short. Ok, not penis~

Inserted another chest tube!!

I have 2 chest tubes!!

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It was very painful with pain score 10/10!

Post-chest tube my wife called the Acute pain service (APS) specialist to come and take a look..

So basically I tried almost all the painkillers!

  1. PCA IV Fentanyl
  2. IV Dynastat
  3. IV Morphine
  4. IM Pethidine
  5. IV Tramal
  6. C. Tramal
  7. C. Celebrax
  8. C. Volren
  9. T. PCM

And I looked like ah soh when I want to go toilet!IMG_2897

I have to put my 2 underwater seal system in the basket for easier mobility.

The 2 chest tubes was connected to proper low-pressure suction pump.

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The underwater seal system

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After 1 week on chest tubes, my lung slowly expanded.. also with the help of this

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Removed chest tube one by one, with repeat x-ray every morning at 6am!

Finally lung fully expanded without the need for surgery after almost 2 weeks in hospital!

Some take home messages after 2 time kena pneumothorax!

  1. Insert chest tube at safety triangle
  2. Always give painkillers & some sedations before inserting chest tube
  3. Use a bigger size 28-32Fr chest tube and anchored at 13-15cm NOT 8-10cm
  4. Connect to low-pressure suction at 6-8kPa to aid recovery
  5. Recurrent rate is 33% without operation
  6. Recurrent rate is 5% with VATS
  7. Recurrent rate is 1% with open surgery
  8. Do chest physio kao kao

Yes, some places the teaching is to anchor at 8-10cm and I tell u what, my 1st chest tube anchored at 8-10cm came off itself about 1cm in ward & I have to insert another one deeper.

So anchoring at 8-10cm is not doing any good to the patient.

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About LWJ

A doctor in Hospital Sultanah Aminah Johor Bahru (HSAJB).