Pneumothorax and air-leak syndromes — viva

Opening (must-hit)

"With any air leak my first question is whether it is under tension, because that changes the next sixty seconds. A shocked child with unilateral absent breath sounds, distended neck veins and a shifted trachea has a tension pneumothorax, which I decompress on clinical grounds before any imaging. Once stable, I ask why the lung leaked — primary spontaneous on a normal lung, secondary on abnormal lung, traumatic, or neonatal — then I size the leak and escalate from oxygen and observation through aspiration and drainage to surgery, while treating the underlying cause." ^{[1] [2] [5]}