Pneumothorax

• Pneumothorax

  • Pneumothorax is the presence of air in the intrapleural space
  • An abnormal communication between either
  • The alveoli and the pleural space e.g. emphysema (spontaneous) or
  • The atmosphere and the pleural space e.g. stab wound (traumatic)
  • Loss of negative intrapleural pressure results in lung collapse
• Pneumothorax – Clinical Features

  • Pain – disruption to parietal pleura which is innervated by pain receptors causing stabbing pain
  • Breathlessness - due to lung being collapsed there is a great decrease in surface area for gas exchange causing a decrease in oxygen levels
  • Reduced breath sounds on auscultation
  • Reduced oxygen levels in the blood (hypoxaemia) - due to lung being collapsed there is a great decrease in surface area for gas exchange causing a decrease in oxygen levels
  • Chest x-ray changes
• Tension Pneumothorax:

  • a very rapid build up of air in the pleural space
  • your heart gets pushed over to the right
• Tension Pneumothorax

  • Mediastinal shift AWAY from the side of the pneumothorax
  • Life threatening – heart wont be able to fill as effectively so output from the heart will be reduced, causing a heart attack
• Management of a Pneumothorax:

  • Intercostal drain (ICD) inserted to restore negative intrapleural pressure
  • Excess air will flow out of the pleural space into the chest drain bottle (bubbling)
  • Lung will reinflate
  • If pleura has healed then ICD can be removed
  • Surgery may be required if there is a persistent air leak
• Physiotherapy Intervention:

  • Ensure adequate analgesia
  • Gentle shoulder ROM exercises
  • Thoracic postural advice
  • Main aim of treatment is to increase lung volume
  • Increase lung volume with positioning, deep breathing exercises and physical exercise e.g. walking or exercise bike
  • lung volume is highest when standing or sitting
• Intercostal drains – what you need to know:

  • Underwater seal to ensure drainage away from patient (keep drainage bottle upright)
  • Keep the drainage bottle below the level of the patient’s chest
  • Clamp the tubing (as briefly as possible) if you have to lift the bottle above the patient’s chest
• Intercostal drains – what you need to know:

  • ICD may be bubbling, swinging or static
  • Never clamp a bubbling ICD – bubbling ICD's indicate a air leak, so clamping it blocks air from leaving and it goes back into the pleural space
  • Always assess the ICD before and after treatment to check not been dislodged or kinked
  • If ICD falls out – cover with glove and then sterile gauze as quickly as possible – to prevent air from getting sucked in, collapsing the lung