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Chapter 22Chapter 22 PneumothoraPneumothora
GA
DD
CL
!natomic !lterations o" the #ungs !natomic !lterations o" the #ungs
#ung collapse#ung collapse
Chest $all epansionChest $all epansion
'tiology(& )ays'tiology(& )ays
*rom the lungs through a per"oration o" the*rom the lungs through a per"oration o" the %isceral pleura%isceral pleura
*rom the surrounding atmosphere through a*rom the surrounding atmosphere through a per"oration o" the chest $all and parietalper"oration o" the chest $all and parietal pleura or, rarely, through an esophagealpleura or, rarely, through an esophageal "istula or a per"orated abdominal %iscus"istula or a per"orated abdominal %iscus
Pneumothora Classi"icationsPneumothora Classi"ications /eneral erms/eneral erms
Closed pneumothoraClosed pneumothora
pen pneumothorapen pneumothora
ension pneumothoraension pneumothora
Pneumothora Classi"icationsPneumothora Classi"ications 3ased on rigin3ased on rigin
raumatic pneumothoraraumatic pneumothora
Spontaneous pneumothoraSpontaneous pneumothora
Iatrogenic pneumothoraIatrogenic pneumothora
Figure 22-3. losed !tension" pneumothorax producedFigure 22-3. losed !tension" pneumothorax produced #y a chest $all $ound.#y a chest $all $ound.
Copyright © 2006 by Mosby, Inc.Slide 4
Spontaneous PneumothoraSpontaneous Pneumothora
Iatrogenic PneumothoraIatrogenic Pneumothora
Copyright © 2006 by Mosby, Inc.Slide 10
%er%ie$ o" the Cardiopulmonary%er%ie$ o" the Cardiopulmonary Clinical Mani"estations !ssociatedClinical Mani"estations !ssociated
$ith P7'8M9:!;$ith P7'8M9:!; he "ollo$ing clinical mani"estations result "romhe "ollo$ing clinical mani"estations result "rom
the pathophysiologic mechanisms caused orthe pathophysiologic mechanisms caused or
acti%ated- byacti%ated- by AtelectasisAtelectasis see *igure +4-(thesee *igure +4-(the
ma<or anatomic alterations o" the lungsma<or anatomic alterations o" the lungs
Copyright © 2006 by Mosby, Inc.Slide 12
Clinical =ata btained at theClinical =ata btained at the Patient>s 3edsidePatient>s 3edside
?ital signs?ital signs
Stimulation o" peripheral chemoreceptorsStimulation o" peripheral chemoreceptors
ther possible mechanismsther possible mechanisms
@ =ecreased lung compliance=ecreased lung compliance
@ !cti%ation o" the de"lation receptors !cti%ation o" the de"lation receptors
@ !cti%ation o" the irritant receptors !cti%ation o" the irritant receptors
@ Stimulation o" the A receptorsStimulation o" the A receptors
@ PainBanietyPainBaniety
Copyright © 2006 by Mosby, Inc.Slide 1
Clinical =ata btained at theClinical =ata btained at the Patient>s 3edsidePatient>s 3edside
CyanosisCyanosis
Chest assessment "indingsChest assessment "indings
9yperresonant percussion note o%er the9yperresonant percussion note o%er the pneumothorapneumothora
=iminished breath sounds o%er the pneumothora=iminished breath sounds o%er the pneumothora
racheal shi"tracheal shi"t
=isplaced heart sounds=isplaced heart sounds
Increased thoracic %olume on the a""ected sideIncreased thoracic %olume on the a""ected side
@ Particularly in tension pneumothoraParticularly in tension pneumothora
Copyright © 2006 by Mosby, Inc.Slide 1
Copyright © 2006 by Mosby, Inc.Slide 16
Copyright © 2006 by Mosby, Inc.Slide 14
Copyright © 2006 by Mosby, Inc.Slide 15
Clinical =ata btained "romClinical =ata btained "rom #aboratory ests and Special#aboratory ests and Special
ProceduresProcedures
Copyright © 2006 by Mosby, Inc.Slide 1
Pulmonary *unction StudyPulmonary *unction Study #ung ?olume and Capacity *indings#ung ?olume and Capacity *indings
0 R FR 0
7mall &neumothorax7mall &neumothorax
!cute al%eolar hyper%entilation $ith hypoemia !cute al%eolar hyper%entilation $ith hypoemia
p8 &a92 893 - &a92
!7lightly"
0ime and &rogression of :isease
100
0
&0
50
0
10
20
0
declines enough to
declines enough to
o r & a 9 2
arge &neumothoraxarge &neumothorax
!cute %entilatory "ailure $ith hypoemia !cute %entilatory "ailure $ith hypoemia
p8 &a92 893 - &a92
!7lightly"
0ime and &rogression of :isease
100
0
&0
50
0
declines enough to
declines enough to
begins to become "atigued
Point at $hich disease
begins to become "atigued
ygenation Indicesygenation Indices
ormal !se'ere"
924R 7'92
9emodynamic Indices9emodynamic Indices #arge Pneumothora-#arge Pneumothora-
&& RA&RA& &A&A &=&&=&
:adiologic *indings:adiologic *indings
Chest radiographChest radiograph
Increased translucencyIncreased translucency
Mediastinal shi"t to una""ected sideMediastinal shi"t to una""ected side in tension pneumothorain tension pneumothora
=epressed diaphragm=epressed diaphragm
#ung collapse#ung collapse
Copyright © 2006 by Mosby, Inc.Slide 24
Copyright © 2006 by Mosby, Inc.Slide 25
Figure 22-1. A, :e'elopment of a small tension pneumothorax in the lo$er part of the right lungFigure 22-1. A, :e'elopment of a small tension pneumothorax in the lo$er part of the right lung (arrow).(arrow). , 0he same pneumothorax 3 minutes later. ote the shift of the heart and mediastinum to the left a$ay, 0he same pneumothorax 3 minutes later. ote the shift of the heart and mediastinum to the left a$ay
from the tension pneumothorax. Also note the depression of the right hemidiaphragmfrom the tension pneumothorax. Also note the depression of the right hemidiaphragm (arrow).(arrow).
A
/eneral Management o"/eneral Management o" PneumothoraPneumothora
D20E(gas should be e%acuatedD20E(gas should be e%acuated
7egati%e pressure( to 12 cm 97egati%e pressure( to 12 cm 922
/eneral Management o"/eneral Management o" PneumothoraPneumothora
:espiratory care treatment protocols:espiratory care treatment protocols
ygen therapy protocolygen therapy protocol
9yperin"lation therapy protocol9yperin"lation therapy protocol
Mechanical %entilation protocolMechanical %entilation protocol
/eneral Management o"/eneral Management o" PneumothoraPneumothora
P#'8:='SISP#'8:='SIS
Chemical or medication in<ected into the chestChemical or medication in<ected into the chest ca%ityca%ity
alcalc
etracyclineetracycline
Produces in"lammatory reaction bet$een lungsProduces in"lammatory reaction bet$een lungs and inner chest ca%ityand inner chest ca%ity
Classroom =iscussionClassroom =iscussion Case Study PneumothoraCase Study Pneumothora
GA
DD
CL
!natomic !lterations o" the #ungs !natomic !lterations o" the #ungs
#ung collapse#ung collapse
Chest $all epansionChest $all epansion
'tiology(& )ays'tiology(& )ays
*rom the lungs through a per"oration o" the*rom the lungs through a per"oration o" the %isceral pleura%isceral pleura
*rom the surrounding atmosphere through a*rom the surrounding atmosphere through a per"oration o" the chest $all and parietalper"oration o" the chest $all and parietal pleura or, rarely, through an esophagealpleura or, rarely, through an esophageal "istula or a per"orated abdominal %iscus"istula or a per"orated abdominal %iscus
Pneumothora Classi"icationsPneumothora Classi"ications /eneral erms/eneral erms
Closed pneumothoraClosed pneumothora
pen pneumothorapen pneumothora
ension pneumothoraension pneumothora
Pneumothora Classi"icationsPneumothora Classi"ications 3ased on rigin3ased on rigin
raumatic pneumothoraraumatic pneumothora
Spontaneous pneumothoraSpontaneous pneumothora
Iatrogenic pneumothoraIatrogenic pneumothora
Figure 22-3. losed !tension" pneumothorax producedFigure 22-3. losed !tension" pneumothorax produced #y a chest $all $ound.#y a chest $all $ound.
Copyright © 2006 by Mosby, Inc.Slide 4
Spontaneous PneumothoraSpontaneous Pneumothora
Iatrogenic PneumothoraIatrogenic Pneumothora
Copyright © 2006 by Mosby, Inc.Slide 10
%er%ie$ o" the Cardiopulmonary%er%ie$ o" the Cardiopulmonary Clinical Mani"estations !ssociatedClinical Mani"estations !ssociated
$ith P7'8M9:!;$ith P7'8M9:!; he "ollo$ing clinical mani"estations result "romhe "ollo$ing clinical mani"estations result "rom
the pathophysiologic mechanisms caused orthe pathophysiologic mechanisms caused or
acti%ated- byacti%ated- by AtelectasisAtelectasis see *igure +4-(thesee *igure +4-(the
ma<or anatomic alterations o" the lungsma<or anatomic alterations o" the lungs
Copyright © 2006 by Mosby, Inc.Slide 12
Clinical =ata btained at theClinical =ata btained at the Patient>s 3edsidePatient>s 3edside
?ital signs?ital signs
Stimulation o" peripheral chemoreceptorsStimulation o" peripheral chemoreceptors
ther possible mechanismsther possible mechanisms
@ =ecreased lung compliance=ecreased lung compliance
@ !cti%ation o" the de"lation receptors !cti%ation o" the de"lation receptors
@ !cti%ation o" the irritant receptors !cti%ation o" the irritant receptors
@ Stimulation o" the A receptorsStimulation o" the A receptors
@ PainBanietyPainBaniety
Copyright © 2006 by Mosby, Inc.Slide 1
Clinical =ata btained at theClinical =ata btained at the Patient>s 3edsidePatient>s 3edside
CyanosisCyanosis
Chest assessment "indingsChest assessment "indings
9yperresonant percussion note o%er the9yperresonant percussion note o%er the pneumothorapneumothora
=iminished breath sounds o%er the pneumothora=iminished breath sounds o%er the pneumothora
racheal shi"tracheal shi"t
=isplaced heart sounds=isplaced heart sounds
Increased thoracic %olume on the a""ected sideIncreased thoracic %olume on the a""ected side
@ Particularly in tension pneumothoraParticularly in tension pneumothora
Copyright © 2006 by Mosby, Inc.Slide 1
Copyright © 2006 by Mosby, Inc.Slide 16
Copyright © 2006 by Mosby, Inc.Slide 14
Copyright © 2006 by Mosby, Inc.Slide 15
Clinical =ata btained "romClinical =ata btained "rom #aboratory ests and Special#aboratory ests and Special
ProceduresProcedures
Copyright © 2006 by Mosby, Inc.Slide 1
Pulmonary *unction StudyPulmonary *unction Study #ung ?olume and Capacity *indings#ung ?olume and Capacity *indings
0 R FR 0
7mall &neumothorax7mall &neumothorax
!cute al%eolar hyper%entilation $ith hypoemia !cute al%eolar hyper%entilation $ith hypoemia
p8 &a92 893 - &a92
!7lightly"
0ime and &rogression of :isease
100
0
&0
50
0
10
20
0
declines enough to
declines enough to
o r & a 9 2
arge &neumothoraxarge &neumothorax
!cute %entilatory "ailure $ith hypoemia !cute %entilatory "ailure $ith hypoemia
p8 &a92 893 - &a92
!7lightly"
0ime and &rogression of :isease
100
0
&0
50
0
declines enough to
declines enough to
begins to become "atigued
Point at $hich disease
begins to become "atigued
ygenation Indicesygenation Indices
ormal !se'ere"
924R 7'92
9emodynamic Indices9emodynamic Indices #arge Pneumothora-#arge Pneumothora-
&& RA&RA& &A&A &=&&=&
:adiologic *indings:adiologic *indings
Chest radiographChest radiograph
Increased translucencyIncreased translucency
Mediastinal shi"t to una""ected sideMediastinal shi"t to una""ected side in tension pneumothorain tension pneumothora
=epressed diaphragm=epressed diaphragm
#ung collapse#ung collapse
Copyright © 2006 by Mosby, Inc.Slide 24
Copyright © 2006 by Mosby, Inc.Slide 25
Figure 22-1. A, :e'elopment of a small tension pneumothorax in the lo$er part of the right lungFigure 22-1. A, :e'elopment of a small tension pneumothorax in the lo$er part of the right lung (arrow).(arrow). , 0he same pneumothorax 3 minutes later. ote the shift of the heart and mediastinum to the left a$ay, 0he same pneumothorax 3 minutes later. ote the shift of the heart and mediastinum to the left a$ay
from the tension pneumothorax. Also note the depression of the right hemidiaphragmfrom the tension pneumothorax. Also note the depression of the right hemidiaphragm (arrow).(arrow).
A
/eneral Management o"/eneral Management o" PneumothoraPneumothora
D20E(gas should be e%acuatedD20E(gas should be e%acuated
7egati%e pressure( to 12 cm 97egati%e pressure( to 12 cm 922
/eneral Management o"/eneral Management o" PneumothoraPneumothora
:espiratory care treatment protocols:espiratory care treatment protocols
ygen therapy protocolygen therapy protocol
9yperin"lation therapy protocol9yperin"lation therapy protocol
Mechanical %entilation protocolMechanical %entilation protocol
/eneral Management o"/eneral Management o" PneumothoraPneumothora
P#'8:='SISP#'8:='SIS
Chemical or medication in<ected into the chestChemical or medication in<ected into the chest ca%ityca%ity
alcalc
etracyclineetracycline
Produces in"lammatory reaction bet$een lungsProduces in"lammatory reaction bet$een lungs and inner chest ca%ityand inner chest ca%ity
Classroom =iscussionClassroom =iscussion Case Study PneumothoraCase Study Pneumothora