what are the 2 main problems faced by MD's when they have a patient with a pneumothorax?

Answer 1

Immediate treatment is a must when a patient comes in with pneumothorax .If there is any kind of delay in treatment the patient becomes short of breath and ultimately dies.
It is very important for the doc to recognize the condition in the ER. One way of suspecting the problem is by auscultation (listening to breath sounds) which are in most cases absent.

Answer 2

The emergency is much greater with a TENSION pneumothorax than with an OPEN pneumothorax. The 2 main problems with a tension pneumo are breathing and circulation. In a tension pneumo, air leaks out of the lungs and fills the chest cavity. In a short time, the air pressure inside the chest cavity builds up and progressively compresses the lungs and heart and shifts the great vessels away from their usual course.
Of course once the lung is compressed it is no longer working and no oxygen can get into it. The circulation also suffers as the pressure squeezes the heart preventing it from beating properly.
The treatment is to convert the pneumo from a tension to an open pneumo by inserting a large needle thru the chest wall allowing the pressure to escape.
Once this is performed, the lifethreatening immediate emergency is over and once the patient is stabilized a chest tube can be placed to treat the open pneumo.

Answer 3

I do a lot of nightshifts in Emergency, where we don't have after hours radiology...we can call a radiographer in if it's urgent/necessary. If it's not tension pneumo clinically, and the diagnosis of PTX is uncertain, the dilemma is "should I call the radiographer in?"
My other dilemma is "should I put a chest drain in myself or let the dayshift do it coz it's close to finishing time"!!