U01.16.043 Pneumothorax

Pneumothorax is the accumulation of air in the pleural space, leading to respiratory distress and changes in normal lung function.

Clinical Presentation

Symptoms and Signs

Dyspnea: Shortness of breath
Chest Pain: Sharp or stabbing pain on the affected side
Uneven Chest Expansion: Asymmetry during respiration
Physical Exam Findings:
- Decreased tactile fremitus on the affected side
- Hyperresonance on percussion
- Diminished breath sounds on auscultation

Types of Pneumothorax

Type	Description	Population at Risk
Primary Spontaneous	Rupture of apical subpleural blebs or cysts. Most common in tall, thin, young males and smokers.	Tall, thin young males; smokers
Secondary Spontaneous	Occurs due to underlying lung disease (e.g., bullae in emphysema, infections).	Individuals with lung diseases; those on mechanical ventilation
Traumatic	Results from blunt trauma (e.g., rib fracture), penetrating trauma (e.g., gunshot), or iatrogenic causes (e.g., central line placement).	Trauma patients; patients undergoing certain medical procedures
Tension Pneumothorax	Air enters the pleural space but cannot exit, leading to increased pressure and potential mediastinal shift.	Can occur from any of the above types

Pathophysiology

In tension pneumothorax, the trapped air increases intrathoracic pressure, leading to mediastinal displacement and kinking of the inferior vena cava (IVC). This results in decreased venous return and reduced cardiac output.

Management

Emergency Treatment

Needle Decompression: Immediate intervention for tension pneumothorax
Chest Tube Placement: To facilitate continuous drainage of air and re-expand the lung

Points to Remember

Pneumothorax can be life-threatening, particularly tension pneumothorax, which requires immediate intervention.
Symptoms may vary based on the type and severity of pneumothorax.
Identifying the type of pneumothorax is crucial for proper management.

Bibliography Reference Links

Pneumothorax – National Heart, Lung, and Blood Institute. NHLBI
Clinical Guidelines for the Management of Pneumothorax – American College of Chest Physicians. ACCP
Spontaneous Pneumothorax – UpToDate. UpToDate
Tension Pneumothorax – Merck Manual. Merck Manual

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