CM- pulm -12- Pneumothorax
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| What is the definition of pneumothorax | free air in the chest outside of the lung
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| what can happen if the visceral pleura is perforated or the chest wall and parietal pluera are perforated | air enters plueral space, negative pressure is lost and lung on affected side collapses = pneumothorax
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| What are the 4 classifications of pneumothorax | spnontaneous
traumatic
iatrogenic
tension**
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| Which type of pneumothorax occurs w/o injury air enters pleural cavity via the airway and can be further divided between primary and secondary | spontaneous pneumothorax
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| pneumothorax in pt w/ no known lung disease caused by rupture of a bulla in the lung most often in tall thin men between 20 and 40 yrs old often occurs during exercise | spontaneous primary pneumothorax
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| pnuemothorax in patient w/ known lung disease most often COPD but could be TB, Pneumonia, Asthma, cystic fibrosis, lung cancer. Often severe and life threatening | spontaneous secondary pneumothorax
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| pneumothorax often caused by an injury to the chest wall further classified as open or closed | traumatic pneumothorax
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| What is an open traumatic pneumothorax | air enters pleural cavitity from the outside w/ free communication between exterior and pleural space through an open wound (blowing wound, sucking wound)
May be caused by stab, gunshot or impaled object
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| traumatic pneumothorax w/ air enters the pleural cavity via lungs caused by blunt chest trauma (crushing injury often car crash, fall or crushing chest injury | Closed Pneumothorax- not as apparent as open pneumothorax
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| What pneumothorax is caused by procedure or treatment often gone bad | iatrogenic pneumothorax
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| Type of pneumothorax where air accumulates in the pleural space w/ each breath. increase in intrathoracic pressure shifts mediastinum away from affected lung, compress intrathoracic vessels, can lead to cardiovascular collapse | tensino pneumothorax
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| pneumothorax that can be caused by a piece of tissue forms a one-way valve that allows air to enter the pleural cavity but not to escape, overpressure can build up with every breath | tension pneumothorax
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| the following are common causes of what type of pneumothorax * insertion of a central line * thoracic surgery * thoracentesis * pleural or transbronchial biopsy. | iatrogenic pneumothorax
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| if a scuba diver ascends to quickly what type of pneumothorax are they likely to develop | traumatic closed pneumothorax
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| What are the clinical manifestations of pneumothorax | sudden sharp chest pain
asymmetrical chest expansion
dyspnea
cyanosis
hyper resonance or tympany
breath sounds diminished or absent
respiratory distress
O2 sat decreased
tachypnea
tachycardia
restlessness/anxiety
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| What are the s/s of open pneumothorax | crepitus, sub q empphysema, sucking chest wound
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| what are the s/s of a tension pneumothorax | decreased CO
hypotension
tachycardia
tachypnea
mediastinal shift and tracheal deviation to unaffected side
cardiac arrest
distended neck veins
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| what will you likely see on ABG's in pneumothorax | intial PaCO2 decreased respiratory alkalosis
later= hypoxemia, hypercapnia, acidosis
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| what is the treatment for open pneumothorax | cover immediately with occlusive dressing made air tight with petroleum jelly or clean plastic sheeting
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| what is the tx for small pneumothorax | spontaneous recover- bed rest, generally resolves in 1 to 2 weeks
or remove air with small bore needle inserted into pleural space
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| What is the tx for a larger pneumothorax | chest tube
surgery repair
pleurodesis (glue, very painful, prep with analgesic), O2,
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| What are the complications from recurrent pneumothorax and what should patient stop doing | cardiac damage
d/c smoking, high altitudes, scuba diving, flying in unpressurized aircraft
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