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![ Tension pneumothorax may develop;:
- Ventilated pt[invasive or noninvasive]
- Traumatic chest injury
- During cardiopulmonary resuscitation pt
- Lung disease – acute presentations of asthma
and copd
- Blocked,clamped or displaced chest drains
- Pt undergoing hyperbaric oxygen treatment](https://image.slidesharecdn.com/pneumothrax-160314063315/75/Pneumothrax-30-2048.jpg)
![ Common in pt with emphysematous bullae.
The episodes usually occur on the same side
It can also occur with LAM
[lymphangioleiomyomatosis]](https://image.slidesharecdn.com/pneumothrax-160314063315/75/Pneumothrax-33-2048.jpg)
Uploaded byManju Mulamootll Abraham
Pneumothrax
The document discusses different types of pneumothorax including primary and secondary spontaneous pneumothorax, catamenial pneumothorax, traumatic pneumothorax, and iatrogenic pneumothorax. It describes the causes, symptoms, diagnosis using chest x-ray and CT scan, and management approaches for closed, open and tension pneumothorax conditions. Recurrent pneumothorax is also mentioned as common in patients with emphysematous bullae.
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- 1.
- 2. Air withinthe pleural cavity (i.e. between visceral and parietal pleura) The air enters via a defect in the visceral pleura (e.g. ruptured bulla) or the parietal pleura (e.g. puncture following rib fracture)
- 6. Primary spotaneouspneumothorax: - tall,thin male - smokers - It is due to rupture of apical sub-pleural bleb The gradient of the pleural pressure increases from the lung base to the apex so that alveoli at the lung apex in tall individuals are subject to significantly greater distending pressure than those at the base of the lung, and this predisposes to development of apical sub pleural blebs
- 7. Secondary spontaneouspneumothorax: - it occurs in patients with known lung disease - rupture of emphysematous bullae - rupture of subpleural tuberculous focus - rupture of lung abscess especially staphylococcal - bronchial carcinoma - pulmonary infarction - bronchial asthma
- 8. Catamenial pneumothorax: -rare condition - female – 25 to 30 years - usually on the rt side - association with menstruation - attacks usually occur within 48 hours before or after the onset of menstruation
- 9. Traumatic pneumothorax: -blunt and penetrating injuries to the chest wall, bronchi, lung or esophagus
- 10. Iatrogenic pneumothorax: -following diagnostic or therapeutic interventions( e.g. secondary to transthoracic and transbronchial biopsy, central biopsy, thoracentesis
- 11. A smallpneumothorax may be asymptomatic Sudden onset chest pain dyspnoea
- 12. - cyanosis, rapidthready pulse, pulsus paradoxus and peripheral circulatory failure -Inspection and palpation: dyspnea shallow breathing shift of trachea and mediastinum fullness of the chest diminished chest movement markedly diminished vocal fremitus
- 13. Chest x-ray -mediastinal shift to the opposite side - sharply defined edge of the deflated lung - complete translucency and absence of bronchovascular markings in the area between the edge of the lung and chest wall - CT scan - Computed tomography can be useful in particular situations - USG - USG is used commonly in the evaluation of people who have sustained physical trauma
- 15. •Pencil-thin white line runningparallel to chest wall •No lung markings lateral to the line
- 16.
- 19. Closed spontaneouspneumothorax Open spontaneous pneumothorax Tension pneumothorax
- 21. The communicationbetween pleura and lung seals off and does not reopen Air can neither enter nor leave the pleural space. The trapped air is slowly re-absorbed and the lung re-expands completely in 2to4 weeks. Closed pneumothorax manifests as trivial breathlessness that abates over a few days Pleural space infection is uncommon
- 23. Asymptomatic orsmall pneumothorax: – no need treatment Symptomatic or large pneumothorax: evacuation of the air using a syringe and needle, three way tap and an under water seal system Inserting chest tube into the pleural cavity and connecting it to water seal drainage system or non-return valve
- 24. The communicationbetween bronchus and pleura does not seal off and remains patent, resulting in a bronchopleural fistula Air can freely flow through the bronchopleural fistula, intra pleural pressure and atmospheric pressure remain the same throughout the respiratory cycle. this prevents the re-expansion of the collapsed lung Open pneumothorax usually follows rupture of an emphysematous bulla, a small pleural bleb, a tuberculous cavity or a lung abscess into the pleural space
- 25. Pt presentwith breathlessness that does not improve
- 27. Usually requiressurgical closure though a trial with chest tube insertion with low pressure suction Cauterization of the opening Video assisted thoracoscopic surgery Open thoracotomy and direct closure of the fistula
- 28. The communicationbetween pleura and lung persists It acts one way valve allowing air to enter the pleural space during inspiration, coughing, sneezing and straining, but not allowing it to escape Large amounts of air gets trapped in the pleural space and the intrapleural pressure becomes much higher than the atmospheric pressure
- 29. High intrapleuralpressure results in compression of the underlying lung, as well as gross shift of the mediastinum to the opposite side with consequent compression of the lung also. These patients present with rapidly progressive breathlessness, central cyanosis, rapid thready pulse and signs of peripheral circulatory failure
- 30. Tension pneumothoraxmay develop;: - Ventilated pt[invasive or noninvasive] - Traumatic chest injury - During cardiopulmonary resuscitation pt - Lung disease – acute presentations of asthma and copd - Blocked,clamped or displaced chest drains - Pt undergoing hyperbaric oxygen treatment
- 32. Tension pneumothoraxis an acute medical emergency Introduction of a wide bore plastic cannula, the other end of which is attached to a long rubber tubing, the end of which is placed underwater seal Introduction of an intercostal catheter connected to a water seal drainage system If nothing is available, simple stab on chest wall is sufficient to release pressure
- 33. Common inpt with emphysematous bullae. The episodes usually occur on the same side It can also occur with LAM [lymphangioleiomyomatosis]
- 34. Includes obliterationof the pleural space by artificial pleurodesis-this can be accomplished by intrapleural instillation of an irritant like tetracycline hydrochloride or talc powder Pleural abrasion or parietal pleurectomy or thoracotomy may be attempted.