الاسترواح الصدري

Definition

Pneumothorax is air in the pleural space; the lung loses the negative pressure that keeps it expanded and collapses.

Types

• Primary spontaneous: tall thin young people and smokers
• Secondary spontaneous: with lung disease such as COPD
• Traumatic: after a wound, rib fracture or procedure
• Tension: air enters but cannot leave, compressing the heart and great vessels

Symptoms and signs

• Sudden one-sided chest pain and dyspnoea
• Reduced breath sounds and hyper-resonant percussion
• Tension: hypotension, raised JVP, trachea deviated away

Diagnosis

Chest X-ray or ultrasound. Tension is a clinical diagnosis and does not wait for imaging.

Treatment

• Small and asymptomatic: observation and oxygen
• Large: needle aspiration or a chest drain
• Tension: immediate needle decompression, then a chest drain
• Recurrent: surgical pleurodesis

Nursing care

• Chest-drain care: unit below the chest, watch tidaling and bubbling
• Avoid flying and diving until cleared

Exam point

Tension pneumothorax is diagnosed clinically and treated at once; the trachea deviates away from the affected side.