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Presented by : BHAVIKA SAHU
Roll No. : 25
MBBS FINAL YEAR II
DEPARTMENT OF SURGERY
Lt.BRKM GMC JDP
 Introduction
 Incidence
 Etiology
 Pathophysiology
 Clinical features
-symptoms
-signs
 Management
 Complications
 Differential diagnosis
 Bibliography
 Pneumothorax is the presence of air between the
layers of pleura.
 It is the most common cause of respiratory
insufficiency following chest trauma.
 Pneumothorax can be –
- closed(or simple)
- open
- tension
A tension Pneumothorax develops when
‘one way valve’ air leak occurs either
from the lung or through the chest wall.
 It is an emergency condition.
Patients with trauma tend to have an associated
pneumothorax or tension pneumothorax 20% of the
time.
In cases of severe chest trauma, there is an
associated pneumothorax 50% of the time.
The incidence of traumatic pneumothorax depends
on the size and mechanism of injury.
 TRAUMATIC
 Penetrating chest
trauma
 Blunt force
trauma
 Iatrogenic lung
injury
NONTRAUMATIC
 Mechanical
positive
pressure
ventilation
PATHOPHSIOLOGY
Injury to the lung
Valvular air leak
Lung collapse
Mediastinal shift to
opposite side
Increased intrapleural pressure
Decreased venous return
Decreased ventilation
Hypoxia and cardiac aarest
 SYMPTOMS
- ACUTE CHEST PAIN
- SHORTNESS OF BREATH
- RESTLESSNESS
- ANXIETY
 TACHYPNOEA
 CYANOSIS
 TACHYCARDIA
 JUGULAR VENOUS DISTENSION
 HYPOTENSION
INSPECTION – Decreased chest movements
PALPATION – Mediastinal and trachea shifts to the
Contralateral side.
PERCUSSION – Hyperresonant note.
AUSCULTATION- Absent breath sounds.
MANAGEMENT
• TENSION PNEUMOTHORAX Is a CLINICAL
DIAGNOSIS.
• Management should not Wait for Image
confirmation.
• If the patient is hemodynamically unstable,
then immediate needle decompression must
be performed without delay followed by ICD
insertion and connected to underwater seal.
 14 -16 gauge needle is inserted
through the chest wall .
 In 2nd intercostal space–midclavicular
line
 In 5th intercostal space- just anterior
to Mid axillary line
It is temporizing
measure – it
convert
TENSION
PNEUMOTHORAX
SIMPLE
PNEUMOTHORAX
TRIANGLE OF SAFETY
INTERCOSTAL CHEST TUBE
 Chest tubes are always connected to an
underwater seal bag to prevent air from re –
entering .
 Functioning of chest tube is assessed by
movement of column of fluid in the water bag
.
 Position of the chest tube checked by taking
chest X-ray
INVESTIGATION
CHEST X-RAY
e-FAST
Bar code
sign
 RESPIRATORY FAILURE
 RESPIRATORY ARREST
 CARDIAC ARREST
 SUBCUTANEOUS EMPHYSEMA
 PNEUMOPERICARDIUM
 PNEUMOPERITONEUM
 PROCEDURE COMPLICATIONS
Fistula formation
Infections
 Bleeding
Intercostal nerve injury
 CARDIAC TAMPONADE
 HEMOTHORAX
 PULMONARY EMBOLISM
 MYOCARDIAL INFARCTION
 ACUTE AORTIC DISSECTION
 RIB FRACTURE
 COSTOCHONDRITIS
 DIAPHRAGMATIC INJURY
•BAILEY AND LOVE
•SRB’S MANUAL OF SURGERY
THANK YOU

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Tension pneumothorax

  • 1. Presented by : BHAVIKA SAHU Roll No. : 25 MBBS FINAL YEAR II DEPARTMENT OF SURGERY Lt.BRKM GMC JDP
  • 2.  Introduction  Incidence  Etiology  Pathophysiology  Clinical features -symptoms -signs  Management  Complications  Differential diagnosis  Bibliography
  • 3.  Pneumothorax is the presence of air between the layers of pleura.  It is the most common cause of respiratory insufficiency following chest trauma.  Pneumothorax can be – - closed(or simple) - open - tension
  • 4.
  • 5. A tension Pneumothorax develops when ‘one way valve’ air leak occurs either from the lung or through the chest wall.  It is an emergency condition.
  • 6. Patients with trauma tend to have an associated pneumothorax or tension pneumothorax 20% of the time. In cases of severe chest trauma, there is an associated pneumothorax 50% of the time. The incidence of traumatic pneumothorax depends on the size and mechanism of injury.
  • 7.  TRAUMATIC  Penetrating chest trauma  Blunt force trauma  Iatrogenic lung injury NONTRAUMATIC  Mechanical positive pressure ventilation
  • 8. PATHOPHSIOLOGY Injury to the lung Valvular air leak Lung collapse Mediastinal shift to opposite side
  • 9. Increased intrapleural pressure Decreased venous return Decreased ventilation Hypoxia and cardiac aarest
  • 10.  SYMPTOMS - ACUTE CHEST PAIN - SHORTNESS OF BREATH - RESTLESSNESS - ANXIETY
  • 11.  TACHYPNOEA  CYANOSIS  TACHYCARDIA  JUGULAR VENOUS DISTENSION  HYPOTENSION
  • 12. INSPECTION – Decreased chest movements PALPATION – Mediastinal and trachea shifts to the Contralateral side. PERCUSSION – Hyperresonant note. AUSCULTATION- Absent breath sounds.
  • 13. MANAGEMENT • TENSION PNEUMOTHORAX Is a CLINICAL DIAGNOSIS. • Management should not Wait for Image confirmation. • If the patient is hemodynamically unstable, then immediate needle decompression must be performed without delay followed by ICD insertion and connected to underwater seal.
  • 14.
  • 15.
  • 16.  14 -16 gauge needle is inserted through the chest wall .  In 2nd intercostal space–midclavicular line  In 5th intercostal space- just anterior to Mid axillary line
  • 17. It is temporizing measure – it convert TENSION PNEUMOTHORAX SIMPLE PNEUMOTHORAX
  • 19.
  • 21.  Chest tubes are always connected to an underwater seal bag to prevent air from re – entering .  Functioning of chest tube is assessed by movement of column of fluid in the water bag .  Position of the chest tube checked by taking chest X-ray
  • 24.  RESPIRATORY FAILURE  RESPIRATORY ARREST  CARDIAC ARREST  SUBCUTANEOUS EMPHYSEMA  PNEUMOPERICARDIUM  PNEUMOPERITONEUM
  • 25.  PROCEDURE COMPLICATIONS Fistula formation Infections  Bleeding Intercostal nerve injury
  • 26.  CARDIAC TAMPONADE  HEMOTHORAX  PULMONARY EMBOLISM  MYOCARDIAL INFARCTION  ACUTE AORTIC DISSECTION  RIB FRACTURE  COSTOCHONDRITIS  DIAPHRAGMATIC INJURY
  • 27. •BAILEY AND LOVE •SRB’S MANUAL OF SURGERY

Editor's Notes

  1. Presented by BHAVIKA SAHU ROLL 25 MBBS FINAL YEAR 2 GUIDED BY -DR.PRADEEP PANDEY SIR
  2. Upper border of ribs to prevent neurovascuklar injury.