Pneumothorax is defined as air in the pleural space between the lungs and chest wall. It is classified as spontaneous, traumatic, or iatrogenic. A tension pneumothorax occurs when air enters the pleural space during inspiration but cannot escape during expiration, increasing pressure on the lungs and blood vessels. Symptoms include chest pain and difficulty breathing. Diagnosis is made through chest x-ray. Treatment for primary pneumothorax is needle aspiration or tube drainage if symptoms are severe. Secondary and tension pneumothoraces require tube drainage as they can cause respiratory failure. Tube drainage involves inserting a catheter through the chest wall and connecting it to suction to remove air from the pleural space.

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

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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.

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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

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Intercostal tube drainage

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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