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DYSPNEA EC PNEUMOTHORAX, ANGGRAINI BARUS
1808260110 - Coggle Diagram
DYSPNEA EC PNEUMOTHORAX
DEFINITION, ETIOLOGY & RISK FACTOR
Etiology
Iatrogenic pneumothorax
- Pleural biopsy
- Transbronchial lung biopsy
- Central venous catheter insertion
- Tracheostomy
- Positive pressure ventilation
Tension pneumothorax
- Penetrating or blunt trauma
- Barotrauma due to positive pressure ventilation
- Percutaneous tracheostomy
- Conversion of spontaneous pneumothorax to tension
- Open pneumothorax when occlusive dressing work as one way valve
Diseases associated with secondary
- COPD
- Asthma
- Tuberculosis
- Cystic fibrosis
- Severe ARDS
Definition
A pneumothorax is defined as a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and visceral pleurae inside the chest. The air accumulation can apply pressure on the lung and make it collapse.
Risk Factor
- Smoking
- Tall thin body habitus in an otherwise healthy person
- Pregnancy
- Marfan syndrome
- Familial pneumothorax
TREATMENT
- In any patient presenting with chest trauma, airway, breathing, and circulation should be assessed.
- Needle decompression
- Administration of 100% supplemental oxygen can help reduce the size of the pneumothorax by decreasing the alveolar nitrogen partial pressure.
- Following needle decompression, a chest tube is usually placed, and an immediate CXR is done to assess the resolution of the pneumothorax.
PATHOPHYSIOLOGY
DYSPNEA
PNEUMOTHORAX
Primary Spontaneus Pneumothorax
Tension Pneumothorax
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DIAGNOSIS APPROACH
- On examination, it is essential to assess for signs of respiratory distress, including increased respiratory rate, dyspnea, and retractions.
- On lung auscultation, decreased or absent breath sounds on the ipsilateral side, reduced tactile fremitus, hyper-resonant percussion sounds, and possible asymmetrical lung expansion are suggestive of pneumothorax.
- With tension pneumothorax, patients will have signs of hemodynamic instability with hypotension and tachycardia.
- Cyanosis and jugular venous distension can also be present.
- When a patient is hemodynamically stable, radiographic evaluation is recommended. The initial assessment is with a chest radiograph (CXR) to confirm the diagnosis.
CXR can demonstrate one or more of the following:
- A thin line representing the edge of the visceral pleura
- Effacement of lung markings distally to this line
- Complete ipsilateral lung collapse
- Mediastinum shift away from the pneumothorax in tension pneumothorax
- Tracheal deviation to the contralateral side of tension pneumothorax
- Flattening of the hemidiaphragm on the ipsilateral side (tension pneumothorax)
DIFFERENTIAL DIAGNOSIS
- Pulmonary embolism
- Acute coronary syndrome
- Acute aortic dissection
- Myocardial infarction
- Pneumonia
- Acute pericarditis
- Diaphragmatic injuries
REFERRAL INDICATION
- Referral to a respiratory physician should be made within 24h of admission.
- Complex drain management is best effected in areas where specialist medical and nursing expertise is available.
- Failure of a pneumothorax to re-expand or a persistent air leak should prompt early referral to a respiratory physician, preferably within the first 24 h.
- Such patients may require prolonged chest drainage with complex drain management (suction, chest drain repositioning) and liaison with thoracic surgeons. Drain management is also best delivered by nurses with specialist expertise.
- Surgical referral is discussed in a later section.
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