Final PNEUMO

8/14/2019 Final PNEUMO

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INTRODUCTION

Pneumothorax is a collection of air or gas in the chest or pleural spacethat causes part or all of a lung to collapse.

Normally, the pressure in the lungs is greater than the pressure in thepleural space surrounding the lungs. However, if air enters the pleuralspace, the pressure in the pleura then becomes greater than the pressurein 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, thinmen between the ages of 20 to 40. In addition, people with lungdisorders, such as emphysema, cystic fibrosis, and tuberculosis, are athigher risk for spontaneous pneumothorax. Traumatic pneumothorax isthe result of accident or injury due to medical procedures performed tothe chest cavity, such as thoracentesis or mechanical ventilation. Tensionpneumothorax is a serious and potentially life-threatening condition thatmay be caused by traumatic injury, chronic lung disease, or as a

complication of a medical procedure. In this type of pneumothorax, airenters the chest cavity, but cannot escape. This greatly increasedpressure in the pleural space causes the lung to collapse completely,compresses the heart, and pushes the heart and associated blood vesselstoward the unaffected side.

http://medical-dictionary.thefreedictionary.com/Tuberculosis

http://medical-dictionary.thefreedictionary.com/Thoracentesis

http://medical-dictionary.thefreedictionary.com/Thoracentesis

http://medical-dictionary.thefreedictionary.com/Tuberculosis



Pneumothorax

Pathophysiology:

“Accumulation of air or gas in the

pleural cavity”

Left-sided pneumothorax (onthe right side of the image) onCT scan of the chest with chest

tube in place.

http://en.wikipedia.org/wiki/Image:Pneumothorax_CT.jpg



Pneumothorax

Anatomy Review- Pleuralcavity

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



Pneumothorax

Anatomy review - Breathing

Diaphragm & accessorymuscles move outward

Negative pressure in thethoracic cavity

Negative pressure pullsair into the lungs via thenose and mouth

Diaphragm & accessorymuscle relax ()

air exhaled



Pneumothorax

If the visceral pleuralis perforated or thechest wall & parietalpleural are perforated air enters the pleural

space

negative pressure islost

Lung on the affected

side collapses



Pneumothorax

An abnormal chest x-ray shows the presence of an air pocket (arrows) in thepleural sac surrounding one lung, which has collapsed. This finding is typicalof a severe pneumothorax. A normal chest x-ray is shown on the right forcomparison; the heart (H), lungs (L), vertebrae (v), and collarbone (C) can beseen.



Pneumothorax

Classifications of pneumothorax

Spontaneouspneumothorax with out injury

Air enters thepleural cavity viathe airway

Farther classifiedas: Primary

Secondary







Pneumothorax

TraumaticPneumothorax D/T injury to the

chest wall Further classified

as Open or closed



Pneumothorax

Open Pneumothorax Air enters pleural cavity

via outside A free communication

between the exteriorand the pleural space asthrough an open wound blowing wound sucking wound

may be caused by a

penetrating injury stab wound, gunshot wound impaled object



Pneumothorax

Closedpneumothorax

Air enters the

pleural cavity vialungs D/t/ blunt chest

trauma Car crash Fall Crushing chest

injury



Pneumothorax

Tension Peumothorax air accumulates in the

pleural space with eachbreath.

The remorseless

increase in intrathoracicpressure

massive shifts of themediastinum awayfrom the affected lung

compressingintrathoracic vessels cardiovascular collapse







Pneumothorax

Etiology / Contributingfactors

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.



Pneumothorax

Clinical Manifestations(all types)

Sudden sharp chestpain

Asymmetrical chestexpansion

dyspnea Cyanosis Percussion

Hyper resonance ortympany

Breath sounds diminished Absent



Pneumothorax

Clinical Manifestations (alltypes)

Respiratory distress

O2 Sats

decreased

Tachypnea

Tachycardia

Restlessness/ Anxiety



Pneumothorax

S&S of openpneumothorax

Crepitus (subcutaneous

emphysema)

Sucking chestwound”



Pneumothorax

S&S Tensionpneumothorax

cardiac output Hypotension

Tachycardia(compensatory) Tachypnea Mediastinal shift and

tracheal deviation To the unaffected

side Cardiac arrest Distended neck veins



Pneumothorax

Dx exam and tests HX & PE Chest x-ray ABG’s

Initial PaCO2 Decreased respiratory

alkalosis Later ABG’s

Hypoxemia Hypercapnia Acidosis



Pneumothorax

Treatment - Firstaid: Openpneumothorax

Coverimmediately withan occlusivedressing, madeair-tight with

petroleum jelly orclean plasticsheeting.



Pneumothorax

Tx: Smallpneumothorax

Spontaneous

recovery Bed rest

resolve on its ownin 1 to 2 weeks

Remove with smallbore needleinserted into the

pleural space







Pneumothorax

Complications Recurrent

pneumothorax

D/C smoking high altitudes scuba diving flying in

unpressurized

aircrafts

Cardiac damage

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