Pneumothorax is a term used for free air in the chest cavity. Air leaks from the lung into the space between the lung and the thoracic wall. Depending upon the amount of air present, air may exert pressure on the lung tissue and can lead to lung collapse.
Causes
1. Injury to the chest wall
2. rupture of air sacs in the lung
3. Complication of medical procedures- such as central line placement, Surgery, CPR,
Risk Factors
Men are more affected, and smoking increases the risk as well. Age between 20-40 is affected. History of pneumothorax in the past considerably increases the risk.
Types of Pneumothorax
1) Primary- happens without any cause. Occurs in smokers with no obvious lung disease. In fifty percent of patients, this will occur again.
2) Secondary- occurs in patients with COPD, bronchiectasis, and TB
3) Traumatic- Penetrating and nonpenetrating chest trauma can lead to rupture of the lung tissue. Medical procedures can lead to puncture of the lung.
4) Tension pneumothorax- The pressure exerted by the air in the pleural space becomes greater than the pressure in the lung, leading to total collapse of the lung on the affected side. Further pressure can lead to compression of the heart to the opposite side, leading to compromise of blood return to the heart. This is fatal if it isn’t detected and treated immediately.
Symptoms
1. Sudden onset of chest pain
2. Difficulty in breathing or shortness of breath
3. tightness across the chest
4. increase in heart rate
5. Tension pneumothorax- blood pressure may be low, leading to fainting and shock
Diagnosis
History, chest x-ray, CT scan, and arterial blood gases
Treatment
Treatment depends on the size and the symptoms that it produces. If it is a small pneumothorax with less than 20% of collapse, observation in the hospital is all that is needed. Repeated chest x-rays are recommended to note the decrease in size. If the pneumothorax is greater than 20%, a tube is inserted into the chest. The tube is between the lung and the chest wall, and a low suction drainage is connected to it, to drain the air.
Tension pneumothorax needs immediate attention to avoid fatality. A needle is inserted into the chest to relieve pressure buildup. Repeated pneumothoraces, surgery is recommended.
Complication
1. Recurrence
2. Pneumothorax can lead to decreased oxygen in the blood
3. Cardiac arrest secondary to pressure on the blood vessels.
4. Cardiac collapse
5. Respiratory failure
6. Arrhythmias secondary to hypoxia
7. Death
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