pneumothorax.We identify the two main types of Pneumothorax with its causes and possible treatments. We also analyze a case study involving a 33-year fruit vegetable merchant, who, while delivering merchandise a mini supermarket developed chest pain difficulty breathing. And then subsequently admitted to casualty and diagnosed with pneumothorax.
Pneumothorax which is defined by Light (1995) as the unprecedented entry of air into an individual’s pleural space is a serious ailment. Its pathophysiology described by Combulsier in 1747 (Mohebbi and Rad, 2007). This was after realizing that the noted reduction in the pulmonary function was as a result of lung compression caused by air present in the pleural space as outlined by Sadiron et al., (1997).
Types and causes of Pneumothorax
This type of pneumothorax is caused by the presence of air within a victim’s pleural space. It is a consequence of a blunt or a penetrating trauma with 90% of such injuries being associated with a blunt trauma subjected to the ribs. The result is a fractured rib (s) which causes a trauma to the victim’s pleura (Tpub,2010).
A traumatic pneumothorax is a consequence of either a penetrating or a non-penetrating trauma that to a victim’s chest. In the case of a penetrating chest trauma, the resulting wound makes it possible for air to directly enter the pleural space via the chest wall. The air may also enter via the visceral pleura that exists in the tracheobronchial tree. The non-penetrating trauma however may result as a result of the visceral pleura being lacerated as a secondary ailment to a rib fracture or dislocation. A rather sudden chest compression then abruptly elevates the alveolar pressure and hence causing an alveolar rupture. Once the alveolus rupture occurs, air then enters the interstitial space and then dissects towards the mediastinum or the visceral pleura. A pneumothorax may then develop as a result of the mediastinal or visceral pleural rupture. This then allows air to enter the pleural space (Light, 1995)
Tension pneumothorax is a consequence of the accumulation of air that is under pressure in the pleural space. The condition develops whenever an injured tissue forms a one way valve and thereby allowing air to invade the pleural space and then subsequently preventing air from escaping in a natural way (Sharma and Jindal,2008). The condition then progresses rapidly to a respiratory insufficiency followed by cardiovascular collapse and then death if it is unrecognized and untreated.
The case study
The care of Mr. Colm Reilly, a 33-year-old fruit and vegetable merchant, was delivering his merchandise to a mini supermarket when he developed chest pain and difficulty breathing. He was admitted to casualty, where a Pneumothorax was diagnosed. A chest drain was inserted and admitted to casualty ward.
Mr. Colm Reilly suffers from pneumothorax and since his case requires him to be placed under a thoracostomy tube treatment, it is important to give him a certain class of care in order to enable him to recover fully and to avoid complications associated with thoracostomy tube procedure as pointed out by Al-Tarshihi et al. (2008). The patient should always be checked for possible air leaks as well as any other breathing problems that they may be having. The tube is put in place while medication for is administered to the patient. There are usually no complication after the tube is removed (ATS, 2004).
The Orlando Regional Medical Center (2005) provided the following recommendations for patients having chest tube (CT) treatment.
At this level the chest tube drainage should be less or equal to 2ml/kg/day or less than or equal to 200 ml/day (considering whichever is less) prior to the removal.
The CT can be removed safely at the end-expiration or at end-inspiration. They also pointed out that the chest drain can be removed safely on suction. At this stage, a brief trial of the employed waterseal prior to the chest tube removal may be used in order to allow the leakage of the occult air to become apparent clinically and thereby reducing the need for the chest drain reinsertion as a result of recurrent pneumothorax. Such operations have however been noted to result to increased length of hospitalization.
At this level, the non-mechanically ventilated patients do not require chest X rays (CXRs).The decision to employ CXRs is on the basis of the individual clinical situation as well as the signs and symptoms of the patients. In mechanically ventilated patients, it is necessary to obtain CXR between 1 and 3 hours after the removal of the CT.This is sufficient in positively identifying a recurrent pneumothorax.
Pneumothorax is a serious disease that should be avoided at all cost. Its treatment and management should be carried out with the best practices in mind in order to grant the patient a chance of recovery since the Lung is an integral organ without which the patient cannot live.
Al-Tarshihi, MI, Khamash, FA, Al Ibrahim, AEO (2008). Thoracostomy tube complications and pitfalls: an experience at a tertiary level military hospital http://www.rmj.org.pk/ram_july_dec_08/original_articles/thoracostomy_tube_complications/pdf.pdf
American Thoracic Society (2004). Chest Tube Thoracostomy.
Gupta, D., Hansell, A. And Nichols, T. et al. 2000. Epidemiology of pneumothorax in England.
Thorax 55, 666 — 71.
Sharma, A and Jindal, P (2008). Principles of diagnosis and management of traumatic pneumothorax. J Emerg Trauma Shock. 2008 Jan — Jun; 1(1): 34 — 41.
Kawano, M., Miura, H. And Anan, H. et al. 2002. Treatment of secondary spontaneous pneumothorax complicating silicosis and progressive massive fibrosis. Kurume Med J. 49, 35 — 40.
Light, RW (1995). In Pleural diseases. 3rd ed. Baltimore: Williams and Wilkins; 1995. Pneumothorax; pp. 242 — 77.
Marachiori, E., Ferrira, A. And Muller, N. 2001. Silicoproteinosis: High resolution CT and histologic findings. J Thoracic Imaging 16(2), 127 — 29.
Mohebbi, I and Rad, IS.(2007). Secondary spontaneous pneumothorax in rapidly progressive formsof silicosis: characterization of pulmonary function measurements and clinical patterns. Toxicology and Industrial Health 2007; 23: 125 — 132
Rao, S. And Rau, P.V. 1993. Bilateral spontaneous pneumothorax in silicosis. Indian J. Chest Dis Allied Sci 35(1), 47 — 49.
Orlando Regional Medical Center (2005).Chest tube management.
Purohit, S.D., Gupta, P.R. And Gupta, M.L. et al. 1992. Acute silicosis in handlers of silica powder bags. Lung India 10(4), 145 — 48.
Sadikot, R.T., Greene, T. And Meadows, K. et al. 1997. Recurrence of primary spontaneous pneumothorax. Thorax 52, 805 — 809.
Sahn, S.A. And Heffner, J.E. 2000. Spontaneous pneumothorax. xNEJM 342, 868 — 74.
Tpub (2010). Simple Pneumothorax
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