Pneumothorax_Dea Natalia_130110110190_E3/Respi

SIGN-SYMPTOM
General
chest pain
shortness of breath
nasal flaring
cough
fatigue
hyperresonant percussion
vocal resonance and tactile fremitus
decreased
Secondary

cyanosis (due to hypoxemia)

confusion
coma
hypercapnia

Traumatic
mechanical injury to lung
Tension
tachycardia
tachypnea

PROGNOSIS
depends upon the extent and type of pneumothorax
small spontaneous pneumothorax will generally resolve on its own without treatment
secondary pneumothorax associated with underlying disease, even when small, is much more
serious and carries a 15% mortality (death) rate
recurrence rate for both primary and secondary pneumothorax is about 40%; most recurrences
occur within 1.5 to two years
DIAGNOSIS
1. Physical Exam
2. Chest X-Ray
size of the pneumothorax (i.e. the volume of air in the pleural space) can be determined with a
reasonable degree of accuracy by measuring the distance between the chest wall and the lung
British guideline: measurement should be performed at the level of the hilum (where blood
vessels and airways enter the lung) with 2 cm as the cutof
American guideline: measurement should be done at the apex (top) of the lung with 3 cm
diferentiating between a "small" and a "large" pneumothorax
small amounts of fluid may be noted on the chest X-ray (hydropneumothorax); this may be blood
(hemopneumothorax)
"deep sulcus sign": normally small space between the chest wall and the diaphragm appears
enlarged due to the abnormal presence of fluid
Left pneumothorax. Note the large, well-demarcated area devoid of
lung markings, the tracheal deviation and movement of the heart
away from the afected side. There is also small pleural efusion on
the left side.

3. CT Scan
in trauma, where it may not be possible to perform an upright film
identification of underlying lung lesions e.g. help to identify blebs or cystic lesions
4. USG
commonly used in the evaluation of people who have sustained physical trauma; may be more
sensitive than chest X-rays in the identification of pneumothorax after blunt trauma to the chest
rapid diagnosis in other emergency situations, and allow the quantification of the size of the
pneumothorax
5. Arterial Blood Gas
to measure the level of oxygen
COMPLICATION
recurrent pneumothorax
shock
TREATMENT
1. Observation
most appropriate if the estimated size of the pneumothorax is small (defined as <50% of the
volume of the hemithorax), there is no breathlessness, and there is no underlying lung disease
monitor condition with a series of chest X-rays
bed rest as any exertion may aggravate the collapse
supplemental oxygen
2. Aspiration
in a large PSP (>50%), or in a PSP associated with breathlessness; also be considered in
secondary pneumothorax of moderate size (air rim 12 cm) without breathlessness, with the
diference that ongoing observation in hospital is required even after a successful procedure

administration of local anesthetic and inserting a needle connected to a three-way tap; up to 2.5
liters of air (in adults) are removed
3. Chest Tube
chest tube (or intercostal drain) is the most definitive initial treatment of a pneumothorax
typically inserted in an area under the axilla (armpit) called the "safe triangle", where damage to
internal organs can be avoided; this is delineated by a horizontal line at the level of the nipple and
two muscles of the chest wall (latissimus dorsi and pectoralis major); local anesthetic is applied
often attached to a suction device that continuously removes air from the chest cavity and may
be left in place for several hours to several days
in spontaneous pneumothorax, small-bore (smaller than 14 F, 4.7 mm diameter) tubes may be
inserted by the Seldinger technique, and larger tubes do not have an advantage; in traumatic
pneumothorax, larger tubes (28 F, 9.3 mm) are used
4. Pleurodesis and Surgery
procedure that permanently obliterates the pleural space and attaches the lung to the chest wall
surgery can be performed through small incisions, using a tiny fiberoptic camera and narrow,
long-handled surgical tools
best results are achieved with a thoracotomy (surgical opening of the chest)with identification
of any source of air leakage and stapling of blebsfollowed by pleurectomy (stripping of the
pleural lining) of the outer pleural layer and pleural abrasion (scraping of the pleura) of the inner
layer
5. Aftercare
smoking cessation
advisable to remain of work for up to a week after a spontaneous pneumothorax
air travel is discouraged for up to seven days after complete resolution of a pneumothorax if
recurrence does not occur
underwater diving is considered unsafe after an episode of pneumothorax unless a preventative
procedure has been performed

PREVENTION
preventative procedure (thoracotomy or thoracoscopy with pleurodesis) may be recommended after
an episode of pneumothorax, with the intention to prevent recurrence