5.5 Pneumothorax and Atelectasis Notes

Pneumothorax

Disease Pathology

  • Pneumothorax: Air in the pleural space causes lung collapse.

  • Types:

    • Spontaneous: No trauma.

      • Ruptured alveoli or blebs.

      • Common in tall, young men (10-30 years old) because of pressure differences.

      • Can occur in lung diseases like emphysema.

    • Traumatic: From trauma.

      • Penetrating wounds or rib fractures.

      • May include hemothorax.

      • Caused by medical procedures.

    • Tension: Life-threatening.

      • Air enters but cannot exit.

      • Collapses lung and compresses structures.

Clinical Presentation

  • Symptoms depend on severity.

  • Spontaneous:

    • Chest pain.

    • Increased respiratory rate.

    • Difficulty breathing.

    • Decreased breath sounds.

  • Tension:

    • Trachea deviates.

    • Increased heart rate, decreased output.

    • Jugular vein distention.

    • Subcutaneous emphysema (crackling sensation).

    • Shock signs.

    • Hypoxemia.

Diagnosis and Treatment

  • Diagnosis:

    • Chest X-ray or CT scan.

    • Pulse oximetry and blood gas.

  • Treatment:

    • Small: Observation, oxygen, X-rays.

    • Larger: Air removal via needle or drainage system.

    • Tension: Immediate needle or chest tube insertion.

  • Prevention:

    • Avoid smoking, high altitudes, non-pressurized aircraft, scuba diving.

Atelectasis

Disease Pathology

  • Atelectasis: Incomplete lung expansion.

  • Causes:

    • Airway obstruction.

    • Lung compression.

  • Types and occurrences:

    • Newborns: Lung never inflated.

    • Infants: Impaired expansion (respiratory distress syndrome).

    • Adults:

      • Mucous plug.

      • Compression by fluid (pleural effusion).

      • Tumor mass (cancer).

      • Exudate.

  • Affects alveoli, segments, or entire lobe.

  • Surgery increases risk due to anesthesia, pain, immobility.

  • Prevention:

    • Coughing, deep breathing, changing positions, hydration, ambulation.

Clinical Presentation

  • Symptoms:

    • Tachypnea.

    • Tachycardia.

    • Dyspnea.

    • Cyanosis.

    • Hypoxemia signs.

    • Diminished chest expansion.

    • Decreased breath sounds.

    • Intercostal retractions.

  • Mediastinal Shift:

    • Obstructive: Shift to affected side.

    • Compression: Shift away from affected lung.

Diagnosis and Treatment

  • Diagnosis:

    • Signs and symptoms.

    • Chest X-ray and/or CT scan.

  • Treatment:

    • Reduce obstruction or compression, re-inflate lung