Pneumothorax & Haemothorax
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A pneumothorax is the presence of air in the pleural space, causing partial or full lung collapse. It can be caused by trauma, mechanical ventilation, or ruptured blebs. There are three main types: closed, open, and tension pneumothorax. A tension pneumothorax is a medical emergency where air builds rapidly in the pleural space, compressing the heart and blood vessels. Needle decompression is needed to release trapped air. Hemothorax is the presence of blood in the pleural space, often accompanying an open pneumothorax or lung injury. Diagnosis involves history, exams, imaging, and blood gas tests. Treatment depends on severity but may include aspiration or
Pneumothorax & Haemothorax
- 1. PNEUMOTHORAX & HAEMOTHORAX PRESENTED BY: MR. ABHAY RAJPOOT
- 2. DEFINITION: • A pneumothorax is the presence of air in the pleural space. • As a result of the air in the pleural space, there is partial or complete collapse of the lung. • Pneumothorax associated with trauma may be accompanied by haemothorax, a condition called hemopneumothorax.
- 3. CAUSES: • Blunt trauma. • Crush injury. • Penetrating trauma.
- 4. TYPES OF PNEUMOTHORAX: •Closed pneumothorax •Open pneumothorax •Tension pneumothorax
- 5. CLOSED PNEUMOTHORAX: •Closed pneumothorax is not associated with external wound. •It is caused by rupture of small blebs on the visceral pleural space. •The causes of the blebs are unknown.
- 6. INCIDENCE • This condition occurs most commonly in underweight male cigarette smokers between 20 and 40 years of age .
- 7. CAUSES: • Injury to the lungs from mechanical ventilation. • Injury to the lungs from the insertion of a subclavian catheter. • Perforation of oesophagus • Injury to the lungs from broken ribs. • Ruptured blebs or emphysema in a patient with COPD.
- 8. OPEN PNEUMOTHORAX: • Open pneumothorax occurs when air enters the pleural space through an opening in the chest wall. • Examples include stab, or gunshot wounds and surgical thoracotomy.
- 9. Conti… • An open pneumothorax should be covered with a vented dressing. • A vented dressing is one secured on 3 sides with the fourth side left untapped • This allows air to escape from the vent and decreases the likelihood of tension pneumothorax developing.
- 10. Conti… • If the object that caused the open chest wound is still in place, it should not be removed until a physician is present. • The impaled object should be stabilized with a bulky dressing.
- 11. TENSION PNEUMOTHORAX: • TP is a pneumothorax with rapid accumulation of air in the pleural space, causing severely high intrapleural pressures with resultant tension on the heart and great vessels. • It may result from either an open or a closed pneumothorax.
- 13. Conti.. • In an open chest wound, a flap may act as a one way valve, thus air can enter during inspiration but can not escape. • The intrathoracic pressure increases, lung collapses, and the mediastinum shifts towards the unaffected side which is subsequently compressed. • As the pressure increases CO is altered because of decreased venous return and compression of the venacava and aorta.
- 14. Conti… • TP can also occur with mechanical ventilation and resuscitative efforts. • It can occur if chest tubes are clamped or become blocked in patients with pneumothorax. Unclamping or relief of the obstruction will remedy this situation.
- 15. Conti… • Tension pneumothorax is a medical emergency with both the respiratory and circulatory system affected. • If the tension in the pleural space is not relieved, the patient is likely to die from inadequate CO or severe hypoxemia. • The emergency management is to insert a large bore needle into the chest wall to release the trapped air.
- 16. CLINICAL MANIFESTATIONS: • If the pneumothorax is small – • Mild tachycardia. • Mild dyspnoea. • If the pneumothorax is large – • Respiratory distress. • Shallow or rapid respirations. • Air hunger. • Oxygen desaturation
- 17. Conti.. • Chest pain. • Haemoptysis • On auscultation – • No breath sound over the affected area. • In tension pneumothorax – • Severe respiratory distress.
- 18. Conti.. • Tachycardia. • Hypotension. • Mediastinal displacement with tracheal shift to the unaffected side.
- 19. HEMOTHORAX: • Haemothorax is an accumulation of blood in the intrapleural space. • It is frequently found in association with open pneumothorax and is then called hemopneumothorax.
- 20. CAUSES: • Chest trauma. • Lung malignancy • Complications of anticoagulant therapy • Pulmonary embolus • Tearing of pleural adhesions
- 21. DIAGNOSTIC EVALUATION • History. • Physical examination. • PFT. • Chest X-ray. • ABG or oximetry .
- 22. COLLABORATIVE CARE: • Treatment of the disease depends on the severity of the disease and the underlying cause. • If the amount of air or fluid is minimal, aspiration can be done from the pleural space with a large bore needle. • It is a portable, light weight, one way flutter valve device similar to water seal drain.
- 23. NURSING MANAGEMENT: • Ineffective breathing pattern related to pressure on the lungs as manifested by decreased SpO2, use of accessory muscles during inspiration. • Potential for complications related to hypoxemia. • Imbalanced nutrition less than body requirement related to poor appetite, SOB as evidenced by weight loss. • Insomnia related to anxiety, dyspnoea, depression as evidenced by frequent awakening , prolonged onset of sleep, lethargy, fatigue, irritability.