ABC Primary Assessment of Pneumothorax patient

1. Pneumothorax
Primary Care
ABC

2. ABC protocol
• The ABC Protocol exists to remind the person delivering treatment of the
importance of Airway, Breathing and Circulation to the maintenance of a
patients’ life.
• It is a crucial element in the “Initial Assessment” of a seriously injured
patient.
• Pts. are assessed and treatment priorities are established.
• Pts. chest should be fully exposed prior to assessment.

3. Airway
• Check for symmetry
• If pt. can talk?
• Color of chest
• Drowsiness
• Signs of airway obstruction
• Dyspnea, Gasping, Anxiety, Confusion, Panic, Wheezing
• NB: Assume a cervical spine injury in any pt. with multisystem-trauma, esp.
with an altered level of consciousness or a blunt injury above the clavicle.

4. Breathing
• Chest symmetry should be assessed
• Drowsiness
• Visual inspection & palpitation may reveal injuries to the chest wall
• Percussion may reveal presence of air/blood in the chest
• Hyper-resonant in pneumothorax
• Dull in any form of consolidation (eg Pneumonia)
• Auscultation should be performed to assure air exchange in the lungs.

5. Circulation
• Hemodynamic status assessment is essential (Hypovolemic shock)
• Inspect for any color change/bruising/excessive sweating/pallor
• Also note any obvious bleeding as well as unobservable ones
• Drowsiness

6. (Source: www.firstaidforfree.com)

7. Inspection
• Chest expansion & symmetry
• Trauma/bruising/open-wound
• In drawings (if child)
• Respiratory rate/depth
• Flail chest

8. Palpation
• Any tenderness?
• Check for tracheal deviation
• If (+)ve, then check for apex beat
• Chest expansion
• Tactile fremitus (normally 5cm)
• Peripheries will be cool to touch (i.e. shock)
• Except in Septic shock

9. Percussion
Normally-Resonance
Pneumothorax- Tympanic

10. Auscultation
• Breath sounds (normally-vesicular, Abnormal-crackles,wheeze,stridor)
• Egophony (“e” and “a”)
• Whispering pectoriloquy
• Fremitus (“99”-vibration)

11. Treatment of Pneumothorax
• The treatment principles of pneumothorax include 5 principles:
• Air elimination (through needle aspiration & catheter drainage)
• Reducing air leakage (H2O bath is used)
• Healing the pleural fistula
• Promoting re-expand and
• preventing future recurrences.

12. Malo Tacii