Pneumothorax Definition: presence of air in the pleural space (Management…
Definition: presence of air in the pleural space
no evidence of overt lung disease.
air escapes from lung into pleural space thru rupture of a small pleural bleb / pulmonary end of a pulmonary adhesion
underlying lung disease. (eg. COPD, Asthma, lung abscess)
post biopsy / chest wall injury
:check: the result is acute onset of chest pain and shortness of breath, particularly with secondary spontaneous pneumothoraces
:check:no clinical signs or symptoms in primary spontaneous pneumothorax until a bleb ruptures and causes pneumothorax;
presence of underlying lung disease, and extent of pneumothorax
Hand: Normal/ tachycardia (in tension pneumothorax)
Tongue: Normal/ central cyanosis (in tension pneumothorax)
Neck: Normal / Jugular venous distention (tension pneumothorax)
Restricted movement of the chest at the affected side
Trachea deviated away from the affected side. ( in tension pneumothorax)
Reduced chest expansion
Vocal fremitus diminished or absent at the affected side.
Hyperresonance on percussion (advance)
Air entry and breath sound may be diminished or disappear at the affected side.
Vocal resonance diminished or absent at the affected side.
Adventitious lung sounds (crackles, wheeze; an ipsilateral finding)
Hypotension, hypoxia, chest pain, dyspnea
Types of spontaneous pneumothorax
Closed: communication btwn airway and pleural space seals off as lung deflates and does not re-open
Open: communication btwn airway and pleural space fails to seal and air continues to pass freely btwn bronchial tree and pleural space
Tension:communication btwn airway and pleural space acts as valve. air enters but cannot exit. :arrow_up: intrapleural pressure. pressure cause mediastinal displacement towards opposite side, compression of normal lung, impairment of systemic venous return and cvs compromise
ABG:evaluating hypoxia and hypercarbia and respiratory acidosis.
:check: linear shadow of visceral pleura with lack of lung markings peripheral to the shadow may be observed, indicating collapsed lung.
:check: ipsilateral lung edge may be seen parallel to the chest wall
:check:Small pleural effusions
:check:Mediastinal shift toward the contralateral lung may also be apparent
Management of pneumothorax
• If < 2 cm: discharge and review next day
• If SOB ± > 2 cm rim on CXR: aspirate
• If still unsuccessful: insert intercostal drain.
Primary pneumothorax (lung edges <2cm from chest wall and not breathless): resolves w/out intervention
percutaneous needle aspiration of air
tension pneumothorax: release pressure with blunt cannula
intercostal tube drainage
Closed pneumothorax: x advisable to fly (air expands with altitude)