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Pneumothorax
Introduction
Pneumothorax is a collection of air or gas in the chest or pleural space that
causes part or all of a lung to collapse.
Normally, the pressure in the lungs is greater than the pressure in the pleural
space surrounding the lungs. However, if air enters the pleural space, the
pressure in the pleura then becomes greater than the pressure in the lungs,
causing the lung to collapse partially or completely. Pneumothorax can be either
spontaneous or due to trauma.
If a pneumothorax occurs suddenly or for no known reason, it is called a
spontaneous pneumothorax. This condition most often strikes tall, thin men
between the ages of 20 to 40. In addition, people with lung disorders, such as
emphysema, cystic fibrosis, and tuberculosis, are at higher risk for spontaneous
pneumothorax. Traumatic pneumothorax is the result of accident or injury due to
medical procedures performed to the chest cavity, such as thoracentesis or
mechanical ventilation. Tension pneumothorax is a serious and potentially life-
threatening condition that may be caused by traumatic injury, chronic lung
disease, or as a complication of a medical procedure. In this type ofpneumothorax, air enters the chest cavity, but cannot escape. This greatly
increased pressure in the pleural space causes the lung to collapse completely,
compresses the heart, and pushes the heart and associated blood vessels
toward the unaffected side.
Pathophysiology:
Accumulation of air or gas in the
pleural cavity
Left-sided pneumothorax (on the right
side of the image) on CT scan of thechest with chest tube in place.
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Anatomy Review- Pleural cavity
Visceral pleura
Encases lungs Pleural space/cavity
Area between pleura
Contains fluid (4ml) Fluid prevents friction
Fluid circulated by
lymph system Parietal pleura
Lines chest wall
Anatomy review - Breathing
Diaphragm i & accessory muscles
move outward
Negative pressure in the thoracic cavity
Negative pressure pulls air into the lungs via the nose andmouth
Diaphragm & accessory muscle relax (h) air exhaled
If the visceral pleural is perforated or the chest wall &
parietal pleural are perforated
air enters the pleural space
negative pressure is lost
Lung on the affected side collapses An abnormal chest x-ray shows the presence of an air pocket
(arrows) in the pleural sac surrounding one lung, which has
collapsed. This finding is typical of a severe pneumothorax. Anormal chest x-ray is shown on the right for comparison; the
heart (H), lungs (L), vertebrae (v), and
collarbone (C) can be seen.
Classifications of pneumothorax
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Spontaneous pneumothorax with out injury
Air enters the pleural cavity via the airway Farther classified as:
Primary
Secondary
Spontaneous (Primary) Pneumothorax
Pt. with no known lung disease. D/T a rupture of a bulla in the lung.
Most often tall, thin men between 20 and 40 years
old.
Spontaneous Secondary Pneumothorax
occurs in pt. with known lung disease
most often COPD
Other lung diseases commonly assoc. with Tuberculosis
Pneumonia Asthma
lung cancer
Often severe & life threatening
Traumatic Pneumothorax D/T injury to the chest wall
Further classified as Open or closed
Open Pneumothorax
Air enters pleural cavity via outside
A free communication between the exterior andthe pleural space as through an open wound
blowing wound
sucking wound
may be caused by a penetrating injury
stab wound,
gunshot wound
impaled object
Closed pneumothorax
Air enters the pleural cavity via lungs D/t/ blunt chest trauma
Car crash
Fall Crushing chest injury
Tension Peumothorax
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air accumulates in the pleural space with each breath.
The remorseless increase in intrathoracic
pressure
massive shifts of the
mediastinum away from
the affected lung compressing
intrathoracic vessels cardiovascular collapse
a piece of tissue forms a one-way valve that allows air to enter the pleural cavitybut not to escape, overpressure can build up with every breath
Etiology / Contributing factors
Spontaneous
Lung disease - COPD
Tall, thin men Traumatic
A penetrating chest wound
Barotrauma scuba divers
Iatrogenic Pneumothorax
* insertion of a central line
* thoracic surgery * thoracentesis
* pleural or transbronchial
biopsy.
Clinical Manifestations (all types)
Sudden sharp chest pain
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Asymmetrical chest expansion
dyspnea
Cyanosis Percussion
Hyper resonance or tympany
Breath sounds diminished
Absent
Clinical Manifestations (all types)
Respiratory distress
O2 Sats
decreased Tachypnea
Tachycardia
Restlessness/ Anxiety
S&S of open pneumothorax
Crepitus (subcutaneous emphysema)
Sucking chest wound
S&S Tension pneumothorax
i cardiac output
Hypotension Tachycardia (compensatory)
Tachypnea
Mediastinal shift and tracheal deviation To the unaffected side Cardiac arrest
Distended neck veins
Dx exam and tests
HX & PE
Chest x-ray ABGs
Initial PaCO2
Decreased
respiratory alkalosis Later ABGs
Hypoxemia
Hypercapnia Acidosis
Treatment - First aid: Open pneumothorax
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Cover immediately with an occlusive dressing, made air-tight with petroleum
jelly or clean plastic sheeting.
Tx: Small pneumothorax
Spontaneous recovery
Bed rest resolve on its own in 1 to 2 weeks
Remove with small bore needle inserted into the pleural space
Tx: Larger pneumothorax
Chest tube
Surgery repair
Pleurodesis glue
Very painful
Prep with analgesic
O2 Surgery
Nursing interventions
Closely monitor resp status
Frequent assess
LOC Color
VS
Chest pain? Restlessness?
Chest Tube
Rest/Activity Balance Sedation
Provide a means for communicate
Educate patient & family
Notify MD for: SpO2 < 90% or Change Greater
Than 5% Respiratory Distress
Inadequate Sedation
h Peak Airway Pressure (Especially with Pressure Control Mode)
Complications
Recurrent pneumothorax D/C
smoking
high altitudes scuba diving flying in unpressurized aircrafts
Cardiac damage
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DISTURBANCE IN OXYGENATION
PNEUMOTHORAX
PREPAERD BY;
ALINGAN, M.
TOMADA, S.
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