disorders of chest wall/pleura

chest wall restriction

-work of breathing is increased

-ventilation may be compromised, decreased tidal volume

-due to trauma, deformity, immobilization

how is a chest wall restriction tested for?

-pulmonary function testing (volume, air flow)

-radiography

-arterial blood gas

neuromuscular disease

-disorder than can lead to impairment of respiratory muscle function due to wall restrictions

-associated with muscular dystrophy, Myasthenia graves, Guillain-Barre

what is the most common cause of hospital admission

respiratory difficulty (hypoventilation and hypercapnia)

flail chest

-instability of a portion of the chest wall from rib or sternal fractures

-results in reduced ventilatory efficiency

-3 or more ribs broken in 2 or more places

what type of movement is seen in flail chest?

paradoxical movement of chest during breathing

pneumothorax

-air in pleural space (collapsed lung)

-caused by rupture in visceral pleura or parietal pleura/chest wall

primary pneumothorax

-spontaneous air in pleural space

-unexpected

-most common in men 20-40 years old

secondary pneumothorax

-air in pleural space caused by disease (COPD, injury, trauma)

iatrogenic pneumothorax

-air in pleural space caused by medical treatments

signs and symptoms of pneumothorax

-sudden pleural pain

-tachypnea

-mild dyspnea

-absent, decreased breath sounds

-anxiety

-asymmetrical chest wall expansion

treatment for pneumothorax

-chest tube

-surgery or pleurodesis

tension pneumothorax

-total collapse of the lung

-shift of mediastinal viscera to opposite side

-flap valve leak allows air to enter pleural space during inspiration and prevents air escape during expiration

-pressure rises asmore air enters

tension pneumothorax symptoms

-severe hypoxemia

-tracheal division away from affected lung

-life threatening

tension pneumothorax treatments

-needle compensation

-chest tube thoracostomy

open pneumothorax

-open wound of the chest wall with free communication between pleural space/atmosphere

-rupture in visceral pleura or parietal pleura/chest wall

-air moves in and out of chest in wall opening instead of trachea

open pneumothorax symptoms

-unable to expand the lung

-inadequate ventilation

open pneumothorax treatment

chest tube

pleural effusion

-fluid in the pleural space (blood vessels or lymphatics)

Transudative effusion

-watery, diffuses out of capillaries

exudative effusion

-WBCs and plasma proteins

chylothorax

milky fluid or fat (from injury/infection)

hemothorax

-blood exudate from trauma

empyema

pus (infection, inflammation)

pleural effusion signs and symptoms

-dyspnea

-pleural pain

-small effusions may be undetected

pleural effusion treatments

-thoracentesis

-chest tube

-surgery

hemothorax blood values

-minimal (350 mL)

-moderate (350-1500 mL)

-massive (more than 1500 mL)

hemopneumothorax

-air and blood present in pleural cavity

-decreased breath sounds

empyema

-infected pleural effusion

-pus in pleural space

empyema signs and symptoms

-cyanosis

-fever

-tachycardia

-cough

-pleural pain

empyema treatments

-antimicrobial medications

-drain pleural space

-chest tube