Pneumothorax
A pneumothorax is the presence of air in the pleural space, leading to partial or complete lung collapse.
Types
1. Primary Spontaneous (healthy individuals, blebs rupture)
2. Secondary Spontaneous (underlying lung disease COPD, asthma)
3. Traumatic (chest injury, rib fracture)
4. Tension (medical emergency air trapped under pressure)
Causes
1. Primary Spontaneous: Rupture of small blebs (common in tall, thin young males).
2. Secondary Spontaneous: Underlying lung disease (COPD, TB, cystic fibrosis).
3. Traumatic: Chest injury (stab, gunshot, ribfracture).
4. latrogenic: Medical procedures (central line insertion, lung biopsy, mechanical ventilation).
5. Tension Pneumothorax: Life-threatening; air builds up under pressure, shifting mediastinum.
Symptoms
• Sudden sharp chest pain (worsens with breathing).
• Dyspnea (shortness of breath).
• Tachycardia, tachypnea.
• Hypoxia (low oxygen levels).
• Decreased breath sounds on affected side.
• Hyperresonance on percussion.
• Tension pneumothorax: Hypotension tracheal deviation, distended neck veins.
Diagnosis
1. Chest X-ray (gold standard) – shows lung edge with absent lung markings.
2. CT scan (more detailed).
3. UItrasound (FAST exam in trauma).
4. ABG (may show hypoxemia)
Treatment
1. Small pneumothorax (asymptomatic):
• Observation, supplemental oxygen (helps air reabsorb).
2. Moderate/Large or symptomatic:
• Needle aspiration (for tensionpneumothorax emergency).
• Chest tube (thoracostomy) connected to underwater seal drainage
3. Recurrent pneumothorax:
• Pleurodesis (chemical/surgical) to prevent recurrence.
• Surgery (VATS) for persistent cases,
Complications
• Tension pneumothorax (medical emergency).
• Respiratory failure.
• Re-expansion pulmonary edema (after rapid lung re-inflation).
• Infection/empyema (if chest tube is placed).
Nursing Considerations
• Monitor: Vital signs, 02 saturation, respiratory distress
• Chest tube care: Ensure airtight system, check for bubbling, monitor drainage.
• Positioning: High Fowler’s to ease breathing.
• Pain Management
• Pt education
