Pneumothorax.HR
- 2. INTRODUCTION:- • A collapsed lung. • This condition occurs when air leaks into the space between the lungs and chest wall(pleura). • Approximately 40% of pneumothoraces are traumatic (due to chest wall trauma or iatrogenic procedures). • Spontaneous pneumothorax occurs without a precipitating event in individuals with preexisting lung disease.
- 3. • The air pushes on the outside of your lung and makes it collapse. • Pneumothorax can be a complete lung collapse or a collapse of only a portion of the lung.
- 5. CAUSES:- • Chest injury- • Any blunt or penetrating injury to the chest, • Injuries during physical assaults or car crashes, • Injuries during medical procedures,i.e. insertion of a needle into the chest. • Ruptured air blisters- Small air blisters (blebs) can develop on the top of the lungs. These blebs sometimes burst-allowing air to leak into the space that surrounds the lungs.
- 6. • Lung disease - COPD, pneumonia and cystic fibrosis • Mechanical ventilation - A severe type of pneumothorax can occur in people who need mechanical assistance to breathe. • The ventilator can create an imbalance of air pressure within the chest. The lung may collapse completely.
- 7. TYPESOFPNEUMOTHORAX:- • There are three types of pneumothorax- • 1)open pneumothorax • 2)close pneumothorax • 3)tension pneumothorax
- 8. • 1)Open pneumothorax • Open pneumothorax occurs when air gets into the pleural space from an injury to the chest. • An open pneumothorax means the air in the pleural space communicates freely with the outside environment. • When air can move freely through the chest wall, into and out of the pleural space, the patient is unable to maintain a negative pleural space pressure.(plu. Pressure= atm. Pressure)
- 9. • Because an effective negative pleural space pressure cannot be maintained in both the affected and unaffected hemithorax, the patient’s ability to move air into the lungs is severely diminished. • Lung volumes are decreased, lung compliance is decreased, ventilation–perfusion mismatching is increased, and gas exchange is impaired.
- 10. • 2)Close pneumothorax:- • Closed pneumothorax is when air or gas gets in the pleural space without any outside wound. • This sometimes happens when the lung is already injured somehow, like from diseases such as cancer or cystic fibrosis. • Pleural pressure is negative.
- 12. 3) Tension pneumothorax:- • Air trapped into pleura due to leak in pleuralspace. • A tension pneumothorax means air can enter the pleural space but cannot escape into the external environment. • This is an acute life-threatening situation. • As air continues to enter and become trapped in the pleural space, the intrapleural pressure rapidly increases. • This causes the lung on the involved side to collapse. • The mediastinal structures are pushed away from the affected side.
- 13. • The increased thoracic pressure causes a decrease in venous return, cardiac output falls, and systemic hypotension and shock are the result. • Lung volumes are significantly reduced, lung compliance is decreased, and the alveolar-capillary surface area available for gas exchange is cut by more than 50%
- 14. CLINICALPRESENTATION:- • A steady ache in the chest • Shortness of breath/dyspnea • Breaking out in a cold sweat • Tightness in the chest • Cyanosis • Severe tachycardia • Hypotension
- 15. DIAGNOSIS:- • Possible deviation of mediastinum toward contralateral side • Decreased or absent breath sounds with decreased or absent vocal fremitus on the affected side • Abnormal chest x-ray showing dense-appearing underlying lung tissue; thin, fine line at periphery; and uniform translucency with complete absence of lung markings in area of pneumothorax; possible overexpansion of the affected rib cage with flattening of the hemidiaphragm if pneumothorax is large.
- 18. TREATMENT:- • The definitive treatment of an open pneumothorax is the application of an airtight, sterile dressing over the sucking chest wound and the placement of a chest tube into the pleural space of the affected hemithorax. • The chest tube is connected to suction so that the air and any fluid or blood within the pleural space can be evacuated. • These measures will reexpand the collapsed lung.
- 19. • Mechanical ventilation and supplemental oxygen may be required until the patient can maintain tissue oxygenation independently. • A tension pneumothorax is treated as an emergency by inserting a needle into the pleural space to allow air to escape. • This is immediately followed by placement of a chest tube connected to suction so that air can be continuously evacuated from the pleural space along with any blood or fluid.
- 20. • Pleurodesis in patients with repetitive pneumothorax (a procedure which obliterates the pleural space to prevent future pneumothoraces)