5.5: Pulmonary Disorders — Pneumothorax & Atelectasis

What is pneumothorax?

Presence of air in the pleural space causing partial or complete lung collapse

What are the three main types of pneumothorax?

Spontaneous, traumatic, and tension pneumothorax

What happens in an open pneumothorax?

Air enters during inspiration and exits during expiration

What happens in a tension pneumothorax?

Air enters the pleural space but cannot exit

What structures are compressed in a tension pneumothorax?

Mediastinal structures including the heart

What causes a spontaneous pneumothorax?

Rupture of an alveolus or air-filled bleb

Where are blebs located?

On the surface of the lung

Who is most commonly affected by spontaneous pneumothorax in healthy individuals?

Tall boys and young men aged 10 to 30

Why are tall individuals at higher risk for spontaneous pneumothorax?

Greater pleural pressure differences in the lung

How can lung disease lead to spontaneous pneumothorax?

Gas trapping can cause rupture

Which lung disease is commonly associated with spontaneous pneumothorax?

Emphysema

What causes traumatic pneumothorax?

Penetrating chest wounds or rib fractures

What is hemothorax?

Collection of blood between the chest wall and lung

What medical procedures can cause traumatic pneumothorax?

Needle aspiration, central line insertion, intubation, positive-pressure ventilation, and CPR

Why is tension pneumothorax life-threatening?

It compresses mediastinal structures and can be fatal

What type of injury can lead to tension pneumothorax?

Penetrating chest wound

What is the effect of tension pneumothorax on the lung?

Collapse of the affected lung

What do pneumothorax symptoms depend on?

The severity of the disease process

What are common symptoms of a spontaneous pneumothorax?

Chest pain on the affected side, increased respiratory rate, and difficulty breathing

What happens to breath sounds in pneumothorax?

They are decreased or absent on the affected side

What happens to structures in a tension pneumothorax?

They shift to the unaffected side

What happens to the trachea and mediastinum in tension pneumothorax?

They deviate from the midline

How does heart rate change in tension pneumothorax?

It increases

How does cardiac output change in tension pneumothorax?

It decreases

Why does cardiac output decrease in tension pneumothorax?

Increased intrathoracic pressure

What may happen to the jugular veins in tension pneumothorax?

Distention

What is subcutaneous emphysema?

Air in subcutaneous tissue that crackles when pressed

What serious condition can result from tension pneumothorax?

Shock from impaired cardiac function

Why does hypoxemia occur in pneumothorax?

Lung vessels vasoconstrict and lung function is lost

How is pneumothorax diagnosed?

Chest x-ray or chest CT scan

What tests assess oxygenation in pneumothorax?

Pulse oximetry and arterial blood gas

How is a small spontaneous pneumothorax treated?

Observation, oxygen, and serial chest x-rays

How is a large pneumothorax treated?

Needle aspiration or chest drainage system

What is emergency treatment for tension pneumothorax?

Immediate needle or chest tube insertion

What type of drainage is used in tension pneumothorax treatment?

One-way valve or continuous suction

What is the goal of tension pneumothorax treatment?

Re-inflate the affected lung

What lifestyle changes help prevent pneumothorax recurrence?

Avoid smoking, high altitude, non-pressurized flights, and scuba diving

What is atelectasis?

Incomplete expansion of a lung or portion of a lung

What are the main causes of atelectasis?

Airway obstruction or lung compression

When can atelectasis occur in newborns?

When the lung has never been inflated

What condition in infants can cause atelectasis?

Respiratory distress syndrome

What can cause atelectasis in adults?

Mucus plug, fluid, tumor, exudate, or obstruction

What type of fluid can compress the lung in atelectasis?

Pleural effusion from congestive heart failure

What types of lung areas can be affected by atelectasis?

Alveoli, lung segments, or an entire lobe

When is the risk of obstructive atelectasis increased?

After surgery

What factors after surgery promote atelectasis?

Anesthesia, pain, pain medications, and immobility

What are prevention strategies for atelectasis?

Coughing, deep breathing, repositioning, hydration, and early ambulation

What are common symptoms of atelectasis?

Tachypnea, tachycardia, dyspnea, cyanosis, and hypoxemia

What happens to chest expansion in atelectasis?

It is diminished

What happens to breath sounds in atelectasis?

They are decreased

What are intercostal retractions?

Inward movement of chest muscles during breathing

What happens to the mediastinum in large atelectasis?

It shifts toward the affected side

What happens to the trachea in large atelectasis?

It shifts toward the affected side

What happens to the mediastinum in compression atelectasis?

It shifts away from the affected lung

How is atelectasis diagnosed?

Signs and symptoms with chest x-ray or CT scan

What is the goal of atelectasis treatment?

Reduce obstruction or compression and re-inflate the lung

What treatments help improve atelectasis?

Oxygen, ambulation, deep breathing, and positioning