212804795-Pneumothoraks

8/21/2019 212804795-Pneumothoraks

1/32

Copyright © 2006 by Mosby, Inc.Slide 1

Chapter 22Chapter 22 PneumothoraPneumothora

Figure 22-1. Right-side pneumothorax.Figure 22-1. Right-side pneumothorax.

GA,GA,

Gas accumulation;Gas accumulation;

DD,DD,

depressed diaphragm;depressed diaphragm;

CL,CL, collapsed lung.collapsed lung. Inset,Inset, Atelectasis, a common secondary anatomic alteration of the lungs.Atelectasis, a common secondary anatomic alteration of the lungs.

GA

DD

CL

8/21/2019 212804795-Pneumothoraks

2/32


!natomic !lterations o" the #ungs !natomic !lterations o" the #ungs

#ung collapse#ung collapse

!telectasis !telectasis

Chest $all epansionChest $all epansion

Compression o" the great %eins andCompression o" the great %eins anddecreased cardiac %enous returndecreased cardiac %enous return

8/21/2019 212804795-Pneumothoraks

3/32

Copyright © 2006 by Mosby, Inc.Slide &

'tiology(& )ays'tiology(& )ays

*rom the lungs through a per"oration o" the*rom the lungs through a per"oration o" the%isceral pleura%isceral pleura

*rom the surrounding atmosphere through a*rom the surrounding atmosphere through aper"oration o" the chest $all and parietalper"oration o" the chest $all and parietalpleura or, rarely, through an esophagealpleura or, rarely, through an esophageal"istula or a per"orated abdominal %iscus"istula or a per"orated abdominal %iscus

*rom gas+"orming microorganisms in an*rom gas+"orming microorganisms in anempyema in the pleural space rare-empyema in the pleural space rare-

8/21/2019 212804795-Pneumothoraks

4/32

Copyright © 2006 by Mosby, Inc.Slide

Pneumothora Classi"icationsPneumothora Classi"ications/eneral erms/eneral erms

Closed pneumothoraClosed pneumothora

pen pneumothorapen pneumothora

ension pneumothoraension pneumothora

8/21/2019 212804795-Pneumothoraks

5/32

Copyright © 2006 by Mosby, Inc.Slide

Pneumothora Classi"icationsPneumothora Classi"ications3ased on rigin3ased on rigin

raumatic pneumothoraraumatic pneumothora

Spontaneous pneumothoraSpontaneous pneumothora

Iatrogenic pneumothoraIatrogenic pneumothora

8/21/2019 212804795-Pneumothoraks

6/32


Figure 22-3. losed !tension" pneumothorax producedFigure 22-3. losed !tension" pneumothorax produced#y a chest $all $ound.#y a chest $all $ound.

8/21/2019 212804795-Pneumothoraks

7/32Copyright © 2006 by Mosby, Inc.Slide 4

Figure 22-%. &neumothorax produced #y a rupture in the 'isceral pleuraFigure 22-%. &neumothorax produced #y a rupture in the 'isceral pleurathat functions as a chec( 'al'e.that functions as a chec( 'al'e.

8/21/2019 212804795-Pneumothoraks


Spontaneous PneumothoraSpontaneous Pneumothora

8/21/2019 212804795-Pneumothoraks

9/32Copyright © 2006 by Mosby, Inc.Slide

Iatrogenic PneumothoraIatrogenic Pneumothora

8/21/2019 212804795-Pneumothoraks


%er%ie$ o" the Cardiopulmonary%er%ie$ o" the Cardiopulmonary

Clinical Mani"estations !ssociatedClinical Mani"estations !ssociated$ith P7'8M9:!;$ith P7'8M9:!;

he "ollo$ing clinical mani"estations result "romhe "ollo$ing clinical mani"estations result "rom

the pathophysiologic mechanisms caused orthe pathophysiologic mechanisms caused or

acti%ated- byacti%ated- by AtelectasisAtelectasis see *igure +4-(thesee *igure +4-(thema

8/21/2019 212804795-Pneumothoraks


Figure )-*. Atelectasis clinical scenario.Figure )-*. Atelectasis clinical scenario.

8/21/2019 212804795-Pneumothoraks


Clinical =ata btained at theClinical =ata btained at thePatient>s 3edsidePatient>s 3edside

?ital signs?ital signs

Increased respiratory rateIncreased respiratory rate

Stimulation o" peripheral chemoreceptorsStimulation o" peripheral chemoreceptors ther possible mechanismsther possible mechanisms

@ =ecreased lung compliance=ecreased lung compliance

@ !cti%ation o" the de"lation receptors !cti%ation o" the de"lation receptors

@ !cti%ation o" the irritant receptors !cti%ation o" the irritant receptors@ Stimulation o" the A receptorsStimulation o" the A receptors

@ PainBanietyPainBaniety

Increased heart rate, cardiac output, blood pressureIncreased heart rate, cardiac output, blood pressure

8/21/2019 212804795-Pneumothoraks

13/32Copyright © 2006 by Mosby, Inc.Slide 1&

Figure 22-+. enous admixture in pneumothorax.Figure 22-+. enous admixture in pneumothorax.

8/21/2019 212804795-Pneumothoraks


Clinical =ata btained at theClinical =ata btained at thePatient>s 3edsidePatient>s 3edside

CyanosisCyanosis

Chest assessment "indingsChest assessment "indings

9yperresonant percussion note o%er the9yperresonant percussion note o%er thepneumothorapneumothora

=iminished breath sounds o%er the pneumothora=iminished breath sounds o%er the pneumothora

racheal shi"tracheal shi"t

=isplaced heart sounds=isplaced heart sounds

Increased thoracic %olume on the a""ected sideIncreased thoracic %olume on the a""ected side

@ Particularly in tension pneumothoraParticularly in tension pneumothora

8/21/2019 212804795-Pneumothoraks


Figure 22-. ecause the ratio of extrapulmonary gas to solid tissue increases in aFigure 22-. ecause the ratio of extrapulmonary gas to solid tissue increases in apneumothorax, hyperresonant percussion notes are produced o'er the affected area.pneumothorax, hyperresonant percussion notes are produced o'er the affected area.

8/21/2019 212804795-Pneumothoraks


Figure 22-*. reath sounds diminish as gas accumulates in the intrapleural space.Figure 22-*. reath sounds diminish as gas accumulates in the intrapleural space.

8/21/2019 212804795-Pneumothoraks

17/32


Figure 22-/. As gas accumulates in the intrapleural space, the chest diameterFigure 22-/. As gas accumulates in the intrapleural space, the chest diameterincreases on the affected side in a tension pneumothorax.increases on the affected side in a tension pneumothorax.

8/21/2019 212804795-Pneumothoraks

18/32


Clinical =ata btained "romClinical =ata btained "rom#aboratory ests and Special#aboratory ests and Special

ProceduresProcedures

8/21/2019 212804795-Pneumothoraks

19/32


Pulmonary *unction StudyPulmonary *unction Study#ung ?olume and Capacity *indings#ung ?olume and Capacity *indings

0 R FR 0

or

4R R506

0 R FR 0

or

4R R506

8/21/2019 212804795-Pneumothoraks

20/32


!rterial 3lood /ases !rterial 3lood /ases

7mall &neumothorax7mall &neumothorax

!cute al%eolar hyper%entilation $ith hypoemia !cute al%eolar hyper%entilation $ith hypoemia

p8 &a92 893- &a92

!7lightly"

8/21/2019 212804795-Pneumothoraks

21/32


0ime and &rogression of :isease

100

0

&0

50

0

P a C 1 2

10

20

0

Al'eolar 8yper'entilation

60

40

0 Point at $hich Pa2

declines enough to

stimulate peripheral

oygen receptors

Point at $hich Pa2

declines enough to


oygen receptors

Pa2

:isease 9nset

& a 9 2 o r & a 9 2

Figure %-2. &a92 and &a92 trends during acute al'eolar hyper'entilation.

8/21/2019 212804795-Pneumothoraks

22/32


!rterial 3lood /ases !rterial 3lood /ases

arge &neumothoraxarge &neumothorax

!cute %entilatory "ailure $ith hypoemia !cute %entilatory "ailure $ith hypoemia

p8 &a92 893- &a92

!7lightly"

8/21/2019 212804795-Pneumothoraks

23/32

Copyright © 2006 by Mosby, Inc.Slide 2&

0ime and &rogression of :isease

100

0

&0

50

0

P a 1 2

10

20

0

Al'eolar 8yper'entilation

60

40

0Point at $hich Pa2

declines enough to


oygen receptors

Point at $hich Pa2

declines enough to


oygen receptors

P a C 1

2

Acute entilatory Failure:isease 9nset

Point at $hich diseasebecomes se%ere and patient

begins to become "atigued

Point at $hich diseasebecomes se%ere and patient

begins to become "atigued

& a ; 2

o r

& a ; 2

Figure %-*. &a92 and &a92 trends during acute 'entilatory failure.

8/21/2019 212804795-Pneumothoraks

24/32


ygenation Indicesygenation Indices

8/21/2019 212804795-Pneumothoraks

25/32


9emodynamic Indices9emodynamic Indices#arge Pneumothora-#arge Pneumothora-

&& RA&RA& &A&A &=&&=&

99 77 77

R7=R7= 7=7= &R&R 7R7R

8/21/2019 212804795-Pneumothoraks

26/32


:adiologic *indings:adiologic *indings

Chest radiographChest radiograph

Increased translucencyIncreased translucency

Mediastinal shi"t to una""ected sideMediastinal shi"t to una""ected sidein tension pneumothorain tension pneumothora

=epressed diaphragm=epressed diaphragm

#ung collapse#ung collapse

!telectasis !telectasis

8/21/2019 212804795-Pneumothoraks

27/32


Figure 22-). eft-sided pneumothoraxFigure 22-). eft-sided pneumothorax (arrows).(arrows). ote the shift of the heart andote the shift of the heart and

mediastinum to the right a$ay from the tension pneumothorax.mediastinum to the right a$ay from the tension pneumothorax.

8/21/2019 212804795-Pneumothoraks

28/32


Figure 22-1. A, :e'elopment of a small tension pneumothorax in the lo$er part of the right lungFigure 22-1. A, :e'elopment of a small tension pneumothorax in the lo$er part of the right lung (arrow).(arrow). , 0he same pneumothorax 3 minutes later. ote the shift of the heart and mediastinum to the left a$ay, 0he same pneumothorax 3 minutes later. ote the shift of the heart and mediastinum to the left a$ay

from the tension pneumothorax. Also note the depression of the right hemidiaphragmfrom the tension pneumothorax. Also note the depression of the right hemidiaphragm (arrow).(arrow).

A

8/21/2019 212804795-Pneumothoraks

29/32


/eneral Management o"/eneral Management o"PneumothoraPneumothora

D20E(gas should be e%acuatedD20E(gas should be e%acuated

7egati%e pressure( to 12 cm 97egati%e pressure( to 12 cm 922

Should not eceed negati%e 12 cm 9Should not eceed negati%e 12 cm 922

8/21/2019 212804795-Pneumothoraks

30/32

Copyright © 2006 by Mosby, Inc.Slide &0


:espiratory care treatment protocols:espiratory care treatment protocols

ygen therapy protocolygen therapy protocol

9yperin"lation therapy protocol9yperin"lation therapy protocol

Mechanical %entilation protocolMechanical %entilation protocol

8/21/2019 212804795-Pneumothoraks

32/32

Classroom =iscussionClassroom =iscussionCase Study PneumothoraCase Study Pneumothora

212804795-Pneumothoraks

Documents