Objective 6: Discuss Classification, Signs and Symptoms, and Treatment of Pneumothorax

Pneumothorax

Accumulation of air within the pleural cavity causing partial or complete lung collapse.

Pleural cavity

Space between the visceral and parietal pleura surrounding the lungs.

Visceral pleura

Membrane covering the surface of the lungs.

Parietal pleura

Membrane lining the inside of the chest wall.

Normal intrapleural pressure

Negative pressure that helps keep the lungs expanded against the chest wall.

Effect of air entering the pleural cavity

Disrupts negative pressure and allows the lung to recoil inward and collapse.

Common manifestations of pneumothorax

Sudden chest pain, dyspnea, tachypnea, and decreased or absent breath sounds.

Closed pneumothorax

Air enters the pleural cavity from internal lung tissue or airways without an open chest wall connection.

Secondary pneumothorax

Pneumothorax associated with underlying respiratory disease.

Emphysematous blebs

Weakened areas of lung tissue that may rupture and release air into the pleural cavity.

Open pneumothorax

Air enters the pleural cavity through an opening in the chest wall.

Traumatic pneumothorax

Open pneumothorax caused by chest trauma, such as a stab wound or gunshot wound.

Tension pneumothorax

Life-threatening pneumothorax in which air enters the pleural cavity but cannot escape.

One-way valve effect

Air enters the pleural space during inspiration but becomes trapped during expiration.

Mediastinal shift

Movement of mediastinal structures toward the opposite side due to increasing pressure.

Effect of tension pneumothorax on venous return

Pressure compresses major blood vessels, decreasing blood return to the heart.

Obstructive shock from tension pneumothorax

Severe pressure reduces venous return and cardiac output, causing potentially life-threatening shock.

Small uncomplicated pneumothorax

May be managed with observation and supplemental oxygen when clinically appropriate.

Needle aspiration

Procedure that removes trapped pleural air using a needle or catheter.

Chest tube

A tube inserted into the pleural cavity to remove air and allow lung re-expansion.

Needle decompression

Emergency procedure that rapidly releases trapped air in a tension pneumothorax.

Definitive treatment for tension pneumothorax

Immediate needle decompression followed by chest tube placement.

What is a pneumothorax?

Air entering the pleural cavity, disrupting normal pressure and causing partial or complete lung collapse.

Where does air accumulate during a pneumothorax?

Between the visceral and parietal pleura.

Why does a pneumothorax cause the lung to collapse?

Air disrupts negative intrapleural pressure, allowing the lung's natural elastic recoil to pull it inward.

What are the most common manifestations of pneumothorax?

Sudden chest pain, dyspnea, tachypnea, and decreased or absent breath sounds.

Why does a patient with pneumothorax develop dyspnea?

The collapsed lung cannot participate normally in ventilation and gas exchange.

A nurse auscultates absent breath sounds on one side after chest trauma. What condition should be suspected?

Pneumothorax.

What is a closed pneumothorax?

Air enters the pleural cavity from internal lung tissue without an open chest wall wound.

A patient with emphysema develops a ruptured bleb. What type of respiratory complication can occur?

Secondary pneumothorax.

What is a secondary pneumothorax?

Pneumothorax caused by an underlying respiratory disease.

What is an open pneumothorax?

Air enters the pleural cavity through an opening in the chest wall.

A patient sustains a penetrating chest wound. What type of pneumothorax may develop?

Open or traumatic pneumothorax.

What is the most dangerous type of pneumothorax?

Tension pneumothorax.

What causes a tension pneumothorax?

A one-way valve allows air into the pleural cavity but prevents it from escaping.

Why does intrapleural pressure progressively increase in tension pneumothorax?

More air becomes trapped with each inspiration.

What happens to the affected lung during tension pneumothorax?

It becomes increasingly compressed and collapses.

What is mediastinal shift?

Displacement of mediastinal structures toward the opposite side of the chest.

Why is mediastinal shift dangerous?

It can compress the opposite lung and major blood vessels.

How does tension pneumothorax decrease cardiac output?

Increased intrathoracic pressure decreases venous return, reducing cardiac filling and cardiac output.

What type of shock can develop from tension pneumothorax?

Obstructive shock.

A patient develops severe hypotension, respiratory distress, and absent breath sounds following chest trauma. What emergency should be suspected?

Tension pneumothorax.

What is the immediate treatment for tension pneumothorax?

Emergency needle decompression.

What treatment follows needle decompression?

Chest tube placement to continuously remove air and restore lung expansion.

How may a small uncomplicated pneumothorax be managed?

Observation and supplemental oxygen when appropriate.

What is the purpose of a chest tube in pneumothorax?

Remove trapped pleural air and help restore negative pressure so the lung can re-expand.

What is the difference between open and tension pneumothorax?

Open pneumothorax involves an open chest wall connection; tension pneumothorax traps air and progressively increases pressure.