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  1. Pneumothorax : Physiotherapy Assessment Include Goals And Treatment Ms. Shilpasree Saha BPT, MPT (Cardio Thoracic Disorders) MIAP
  2. Pneumothorax  A pneumothorax is a collection of air outside the lung but within the pleural cavity.  It occurs when air accumulates between the parietal and visceral pleurae inside the chest.  The air accumulation can apply pressure on the lung and make it collapse.
  3.  Air can enter the pleural space by two mechanisms, either by trauma causing communication through the chest wall or from the lung by rupture of the visceral pleura.
  4. Pneumothorax: Traumatic Atraumatic/Spontaneous Primary Secondary
  5.  A primary spontaneous pneumothorax (PSP) occurs automatically without a known eliciting event, while a secondary spontaneous pneumothorax (SSP) occurs after an underlying pulmonary disease.  A traumatic pneumothorax can be the result of blunt or penetrating trauma.
  6.  A simple pneumothorax does not shift the mediastinal structures, as does a tension pneumothorax.  Open pneumothorax is an open wound in the chest wall through which air moves in and out.
  7. Aetiology I. Rupture of a pleural bleb in the region of apex of lung.
  8. Computed tomography (CT) showing blebs. Chest x-ray showing pneumothorax with blebs.
  9. II. Rupture of emphysematous bulla. III. Rupture of lung abscess or tuberculosis lesion into pleural cavity.
  10. a The chest radiography image shows a large lucency occupying the right upper thorax with mediastinal shift and patchy opacities of the left apical area. b The coronal computed tomography image shows giant bullae occupying the right thorax and multiple opacities over the left upper lung
  11. Other causes  Penetrating rib fracture  Penetrating wounds  Accidental opening of pleural cavity during abdominal surgery  Penetration of pleura during central venous pressure catheter insertion.
  12. Physical findings  The most common symptoms are:  Chest pain  Shortness of breath.  The chest pain is pleuritic, sharp, severe, and radiates to the ipsilateral shoulder.
  13. On examination, the following findings are noted:  Diminished chest movement  Absence of breath sound over apex of effected lung.  Respiratory discomfort  Increased respiratory rate  Asymmetrical lung expansion  Decreased tactile fremitus  Hyper resonant percussion note  Decreased intensity of breath sounds or absent breath sounds
  14. In tension pneumothorax following additional findings are seen:  Tachycardia of more than 134 beats per minute  Hypotension  Jugular venous distension  Cyanosis  Respiratory failure  Cardiac arrest
  15. Treatment  A small pneumothorax requires few days of bed rest until it resolves.  A large pneumothorax (›25 percent of pleural space is filled with air) is treated with needle aspiration or by an intercostal drain.  Pleurodesis or pleurectomy may indicated for recurrent pneumothorax.
  16. PT-Treatment  Expansion breathing exercise to reexpand the lung.  Shoulder ROM exercises to maintain shoulder, shoulder girdle and thoracic mobility