2. introduction
Accumulation of atmospheric air in the pleural space, which
results in a rise in intratharacic pressure and reduced vital
capacity. The loss of negative intrapleural pressure results in
collapse of the lung.
3. Definition
Air in the pleural space occurring spontaneously or from
trauma. In patients with chest trauma, it is usually the result
of a laceration to the lung parenchyma, tracheobronchial tree,
or esophagus. The patient's clinical status depends on the rate
of air leakage and size of wound.
4. Etiological factor
When there is a large open hole in the chest wall
Direct chest injury to the chest wall
Spontaneous pneumothorax is usually due to rupture of a
subpleural bleb.
May occur secondary to chronic respiratory diseases or
idiopathically.
May occur in healthy people, particularly in thin, white males
and those with family history of pneumothorax.
5. Types of pneumothorax
Spontaneous pneumothorax sudden onset of air in the pleural
space with deflation of the affected lung in the absence of trauma.
Open pneumothorax (sucking wound of chest)implies an opening
in the chest wall large enough to allow air to pass freely in and
out of thoracic cavity with each attempted respiration.
Tension pneumothorax buildup of air under pressure in the
pleural space resulting in interference with filling of both the
heart and lungs.
6. Clinical manifestation
Tachycardia
Tachypnea
Dyspnea
Hypotension
Cyanosis
Absent breath sounds on affected side
Decreased chest expansion unilaterally
Sharp chest pain
Subcutaneous emphysema as evidenced
by crepitus on palpation
Sucking sound with open chest wound
Tracheal deviation to the unaffected
side with tension pneumothorax
Clinical picture of open or tension
pneumothorax is one of air hunger,
agitation, hypotension, and cyanosis
Mild to moderate dyspnea and chest
discomfort may be present with
spontaneous pneumothorax
8. Management
Spontaneous Pneumothorax
Treatment is generally nonoperative if pneumothorax is
not too extensive.
Observe and allow for spontaneous resolution for less than 50%
pneumothorax in otherwise healthy person.
Needle aspiration or chest tube drainage may be necessary to
achieve reexpansion of collapsed lung if greater than 50%
pneumothorax.
Surgical intervention by pleurodesis or thoracotomy with
resection of apical blebs is advised for patients with
recurrent spontaneous pneumothorax.
9. Tension Pneumothorax
Immediate decompression to prevent cardiovascular
collapse by thoracentesis or chest tube insertion to let air
escape.
Chest tube drainage with underwater-seal suction to allow
for full lung expansion and healing
10. Open Pneumothorax
Close the chest wound immediately to restore adequate
ventilation and respiration.
Patient is instructed to inhale and exhale gently against a closed
glottis (Valsalva maneuver) as a pressure dressing (petroleum
gauze secured with elastic adhesive) is applied. This maneuver
helps to expand collapsed lung.
Chest tube is inserted and water-seal drainage set up to
permit evacuation of fluid/air and produce reexpansion of
the lung.
Surgical intervention may be necessary to repair trauma.
12. Nursing management
Apply a nonporous dressing over an open chest wound.
Administer oxygen as prescribed.
Place the client in a Fowler’s position.
Prepare for chest tube placement, which will remain in
place until the lung has expanded fully.
Monitor the chest tube drainage system. f. Monitor for
subcutaneous emphysema.
