Air in chest which is abnormal and needs management

1. PNEUMOTHORAX

2. 3
What is pneumothorax
• Pleural cavity is a latent closed space, in which there
is no air
• Normally negative pressure exist between the
visceral pleura and parietal pleura allowing the lung
to be filled by chest wall expansion
• Pneumothorax is defined as air in the pleural space
• That is, air between the lung and chest wall, or in
other term, air between the visceral pleura and the
parietal pleura

3. 4
Pneumothorax

4. 5
Classification of
pneumothorax
• Divided into three types
o Spontaneous
having an unknown cause or occurring as a
consequence of the nature course of a disease
process, such as COPD, tuberculosis
Primary
Secondary

5. o Traumatic
following any penetrating or non-penetrating chest
trauma, with or without bronchial rupture
OPEN
CLOSED- no Communication b/n airway and the
pleural space seals off as the lung deflates

7. • Iatrogenic
occurring as the results of diagnostic or therapeutic
medical procedure. Intentional or a complication
• EG- Transthoracic needle aspiration
sublavian catheter insertion
mechanical ventilation

8. Tension pneumothorax
• Communication b/n the airway & the pleural space acts as
a one-way valve
• Allowing air to enter the pleural space during inspiration but
not to escape on expiration
• Large amt of air accumulates progressively in the pleural
space
• Intrapleural pressure increases above atm pressure

9. • Pressure causes mediastinal shift towards the
opposite side
• with compression of the opposite lung
• & impairment of systemic venous return
• Causing cardiovascular compromise

11. Clinical features
• Sudden onset of unliateral pleuritic chest pain
• Breathlessness
[In pts with a small pneumothorax, physical examination may
be normal ]

12. General examination
oCyanosis
oRapid thready pulse
oSigns of peripheral circulatory failure in
severe cases

13. Inspection & palpation
• Dyspnoea
• Accessory muscles of respiration
• Shift of trachea
• Shift of mediastinum to opposite side
• Fullness of chest on the affected side
• Diminished chest movements

14. Percussion
• Hyper-resonant on affected
pneumothorax.

15. Auscultation
• Diminished to absent breath sounds
• Absence of adventitious sounds

16. Investigations
Chest x ray
Shows : increased radiolucency, with
absence of bronchovascular markings
• extend of mediastinal shift.
• pleural fluid ,if present .
• underlying pulmonary disease .
• (costophrenic angles are clear)

19. Treatment

20. Primary pneumothorax
• If the lung edge is < 2cm from the chest
wall and patient is not breathless
↓
Resolves normally with out intervention

21. • If the patient is having severe
symptoms
↓
Percutaneous needle aspiration
↓
If it fails , intercostal tube drainage is done

22. • Tension hemothorax
Air enters the pleural space but cannot escape
acts as a one-way valve

23. PERCUTANEOUS NEEDLE ASPIRATION OF AIR

24. Secondary pneumothorax
Even a small secondary pneumothorax may
cause respiratory failure, so all such patients require
↓
Intercostal tube drainage
[Intercostal drains are inserted in the 4th ,5th or 6th intercostal
space in the midaxillary line ,connected to an under
waterseal]

25. Tension pneumothorax
• It is a medical emergency.
• A large bore needle is inserted into pleural
space through 2nd intercostal space.
• Needle should be left in place until a
thoracostomy tube can be inserted.

26. 27
Intercostal tube drainage
Fix the catheter and cover with gauze
Making a small incision
Using a forceps to extend the hole
Inserting a catheter into pleural cavity

27. 28
Intercostal tube drainage

28. 29
Observation and nursing
care
• No bubble released
o The lung reexpansion
o The chest tube is obstructed by secretion or blood
clot
o The chest tube shift to chest wall, the hole of the
chest tube is located in the chest wall
• If the lung reexpansion, removing the chest tube
24 hours after reexpansion
• Otherwise, the chest tube will be inserted again
or regulated the position