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Pneumothorax class

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Pneumothorax and its various forms with simple treatments

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Pneumothorax class

  1. 1. Dr. Boney Cheriyan Thavalathil Emergency Physician & Intensivist,
  2. 2.  Normal pleural space = closed sac in which negative pressure is essential for normal lung expansion during breathing  What’s the normal pleural pressure?  Beginning of inspiration  - 5 cm H2O  End of inspiration  - 7.5 cm H2O
  3. 3. “Pneumo” – Gas “Thorax” – Chest cavity Occurs when air leaks into the space between the lungs and chest wall, creating pressure against the lung Sources Visceral pleura Ruptured esophagus Chest wall defect Gas-forming organisms
  4. 4. Traumatic Blunt Penetrating Iatrogenic Diagnostic Therapeutic Spontaneous Primary Secondary COPD Infection Neoplasm
  5. 5. Penetrating Trauma Air entering pleural space directly through chest wall Blunt Trauma High Risk Occupations
  6. 6. Transthoracic Needle Aspiration biopsy Transbronchial Biopsy Thoracocentesis Central Venous Catheter Placement Intercostal Nerve Block Tracheostomy Positive Pressure Ventillation NG tube placement
  7. 7. Penetrating & Non- Penetrating trauma Thoracic Spine Fracture Dislocations Cohesive forces between visceral & parietal pleura disrupted Collapse of the lung
  8. 8. Signs Tachypnea Tachycardia Hypotension Hypoxia Symptoms Breathlessness Pleuritic Chest pain Sudden onset Tension pneumothorax Spontaneous pneumothorax
  9. 9. Respiratory Decreased Breath Sounds Hyperresonance to percussion Decreased Tactile Fremitus Altered Mental Status Cardiovascular JVD Shift in mediastinum Other Subcutaneous Emphysema Shifted Trachea
  10. 10. Tension pneumothorax Failure to reexpand Persistent air leak Recurrence Removal of intrapleural air Infection Reexpansion pulmonary edema
  11. 11. Mediastinal shift Kinking of SVC & IVC Decrease in Venous Return to heart Decrease In C.O SHOCK & HYPOPERFUSION
  12. 12. ABG PO2 : decreased PCO2: Decreased from Hyperventilation Elevated with respiratory compromise
  13. 13. CXR Inspiratory & expiratory images Underlying Pul. disease Harder to detect CT PSP – Blebs & Bullae Small pneumothorax Assess the need for thoracotomy
  14. 14. Absence of “lung sliding” as assessed on the time- motion view Demonstration of a "lung point" on the time-motion view Absence of vertical comet-tail artifacts USGUSG  95% sensitivity95% sensitivity  100% specificity100% specificity
  15. 15. “Seashore sign” “Stratosphere sign”
  16. 16. Normal Abnormal
  17. 17. Normal Abnormal
  18. 18. ABC History Examination Needle aspiration and small chest tube drainage Goals  Elimination of intrapleural air  Optimization of pleural healing  Prevention of recurrences
  19. 19. Immediate decompression via chest tube or needle thoracostomy If a tension pneumothorax is present, a “hiss of air” may be heard escaping from the chest cavity Remove the needle, leave the catheter in place Rx
  20. 20. Immediate management Wound dressing Flutter-Type Valve Effect Rx
  21. 21. Clear and manage the airway Provide oxygen Seal an open wound with an occlusive dressing Rx
  22. 22. Tape down three sides and create a flutter valve Rx
  23. 23. Chest tube Remote from the wound Definite management Surgical closure of the wound Rx
  24. 24. Oxygen Pneumothorax is smaller than 15% Patient is asymptomatic Needle aspiration Pneumothorax is smaller than 15% Symptomatic & hemodynamically stable Pigtail catheter Pneumothorax is greater than 15% Rx
  25. 25. Tube Thoracostomy Recurrent Pneumothorax CT to evaluate need for thoracotomy Thoracoscopy with stapling of blebs Pleural abrasion & Sclerosing agent (Doxycycline or Talc) Rx
  26. 26. Aspiration Tube thoracostomy Rx

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