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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.