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What is the definition of Pneumothorax?
Gas buildup in pleural space--->seperating visceral & parietal pleura---->allowing lungs to collapse & chest wall to move outward--->veins & alveoli compressed, get atelectatic--->lower venous return to heart
Where does gas enter the pleural space in a pneumothorax?
- Lungs-hole in visceral pleura
- Surounding atmosphere- opening in chest wall
- Gas forming microorganism in empyema
What happens with gas in a closed & open pneumothorax?
- Closed: not in direct contact with the atmosphere
- Open: direct contact, air movies freely in & out
What happens with the intrapleural pressure in a tension pneumothorax?
Intrapleural pressure exceeds intra-alveolar pressure
What causes a traumatic pneumothorax and is it open or closed?
- penetrating chest wall wounds
- knife, bullet & impaled objects
- Open wound
- Sucking chest wound
What is a spontaneous pneumothorax?
Occurs suddenly & withough obvious cause
Who is a spontaneous pneumothorax common in?
- Young tall people
- 15-35 yrs old
What could a spontaeous pneumo cause?
Valvular pneumo-which is both a closed & tension pneumo
Intrapleural pressure is greater than atmospheric pressure on one side. What type of pneumo?
A crush injury could cause a sharp end of fractured rib to pierce the visceral pleura and let gas leak into the pleural space. What type of pneumo is this?
When does a iatrogenic pneumothorax occur?
- During diagnostic or therapeutic procedure
- pleural or liver bx
- nerve block
- IV start
What happens with a pendelluft & what does it lead to?
- pnuemo on one side
- on inhalation-mediastinum shifts away from the bad side to good
- on exhalation-mediastinum shifts toward bad to good
- Leads to hypoventilation
What are the signs & symptoms of pneumothorax?
- Increased: RR-stim of PCRs & deflation, irratant & J receptors
- Increased: pulse, C.O. & BP
- Decreased: C.O. & BP if tension
- Increased: thoracic volume on affected side
What happens with O2 levels with a pneumo?
- Increase: shunt & O2 extraction
- Decrease: O2 delivery & SvO2
What pressures and resistance are decreased with a pneumothorax?
What pressures & resistance are increased with a pneumothorax?
What are the signs you hear of a pneumothorax?
- Hyperresonant percussion note over affected area
- Decreased BS
What are the ABGS of a pt. with a small & large pneumothorax?
- Small: acute alveolar hyperventilation with hypoxemia
- Large: acute ventilatory failure with hypoxemia
What's the PFT of a pneumo show?
What does the chest x-ray of a pneumothorax show?
- mediastinal shift away
- flat diaphragm
How do you manage a small pneumothorax?
- small pneumo: 15-20% may reabsorb in a month
- bed rest
- limit activity
How do you manage a large pneumothorax?
- If greater than 20%
- Remove gas from pleural space
- Leave tube in another 24-48 hrs before
- PRN 100% O2
- Hyperinflate for atelectais