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Specific pulmonary injuries pneumothorax (collapsed lungs ) :

Specific pulmonary injuries pneumothorax (collapsed lungs ) Conducted by Ms.Monik a (clinical instructor) Army college of nursing ,jalandhar cantt

Definition :

Definition Pneumothorax is a collection of air or gas in the pleural space of the lung, causing the lung to collapse. It prohibits complete lung expansion. Pneumothorax may be the result of an open chest wound that permits the entrance of air, the rupture of an vesicle on the surface of the lung.

Types :

Types Open pneumothorax : results when a penetrating chest wound enables air to rush in and cause the lungs to collapse. Closed pneumothorax: results when the chest wall is punctured or air leaks from a ruptured bronchus (or a perforated esophagus)

Classification :

Classification a) Primary Spontaneous pneumothorax occurs in a previously healthy individual with no prior trauma. This is thought to be due to rupture of a bleb (a blister containing air) on the surface of the lung . It can also caused due to result of another illness in lungs such as COPD ,tb ,cancer. b) traumatic pneumothorax : Traumatic pneumothorax occurs either because a hole in the chest wall, such as a stab wound or gunshot wound , allows air to enter the pleural space, or because of injury to the lung.

c) Tension pneumothorax :

c) Tension pneumothorax pneumothorax resulting from a wound in the chest wall which acts as a valve that permits air to enter the pleural cavity but prevents its escape The accumulation of air under pressure in the pleural space. air enters the pleural cavity it trapped during expiration so the air pressure within the thorax higher than atmospheric pressure, It compresses the lung, and cause cardiopulmonary impairment. Also called pressure pneumothorax ,

Risk factors/etiology :

Risk factors/etiology Spontaneous pneumothorax Bleb or bulla Emphysema Cystic fibrosis Tuberculosis Necrotizing pneumonia Malignancy malfunction Traumatic pneumothorax Chest surgery Insertion of central lines Thoracentasis Gunshot wound Knife wound Penetrating vehicle accidents chest trauma Fractured rib

Physical examination :

Physical examination There may be no abnormalities on physical examination, especially if the pneumothorax is small. The breath sounds as audible by stethoscope may be diminished on the affected side, as air in the pleural space dampens sound. Tension pneumothorax is characterized by rapid breathing, cyanosis, falling blood pressure (hypotension) and confusion. The affected side of the chest may be hyperexpanded In very severe cases, the respiratory rate falls sharply, with shock and coma.

Diagnostic evaluation :

Diagnostic evaluation Chest X-ray- Plain radiograph of the chest, ideally with the X-ray beams being projected from the back (posteroanterior or PA), has been the most appropriate first investigation. Computed tomography : Computed tomography (CT or CAT scan) can be useful in particular situations . Ultrasound : Ultrasound is used commonly in the evaluation of people who have sustained physical trauma

Clinical manifestation :

Clinical manifestation Tachypnea Dyspnea Sudden sharp pain on the affected side with chest movement Breathing Coughing Asymmetrical chest expansion Diminshed or absent sounds Restlessness Anxiety Moderate pneumothorax


Cont………….d b) Severe pneumothorax Distended neck veins emphysema Tracheal deviation Progressive cyanosis

Medical mangement :

Medical mangement Physician prefer to insert a chest tube immediately into the pleural space via the fourth intercostals space. The chest cathteter is connected to closed chest drainage. The catheter permits the continuous escape of air & blood from the pleural space. Thoracotomy can be done to explore the chest surgically & to repair the site of origin of the pneumothorax or hemothorax. Surgical treatment can be accomplished through the VATS (video assisted thoroscopic surgery) . Thorascopy can be done to make the direct visualization of the defect in the chest that needs to be repaired.


Cont………..d VATS is less invasive than an thoracotomy & the client experience less pain . It is also recovered faster with less side effect .

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Hemothorax :


Definition :

Definition Hemothorax may be present in client with chest injuries. A small amount of blood (<300ml) in the pleural space may cause no clinical manifestation. Severe hemothorax (1400 to 2500 ml) may be life threatening .


Cont………d Clinical manifestation: respiratory distress ,shock,dullness upon percussion of the affected side. Diagnosis: a chest x-ray ,

Management :

Management if the client is in severe distress the physician may aspirate blood from the pleural space by inserting a 16 gauze needle into the fifth or sixth intercostal space . To drain intrathoracic accumulation of blood ,the physician inserts a 36 French chest catheter. Which is connected to a drainage system.


Cont………..d An initial drainage of 500 to 1000 ml is considered moderate . Continued large amounts of drainage (200 ml/hr) warrants immediate thoracotomy or the use of VATS to repair the site of active bleeding. Fluid replacement or blood transfusion can be done

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