4/20/2024 0 Comments Hyperresonant lung sounds![]() Increased central venous pressure can result in distended neck veins and hypotension. Patients may have tachypnea, dyspnea, tachycardia, and hypoxia. A tension pneumothorax can cause severe hypotension (obstructive shock) and even death. Pneumothorax enlarges, and the lung gets smaller due to this vital capacity, and oxygen partial pressure decreases. Clinical presentation of a pneumothorax can range anywhere from asymptomatic to chest pain and shortness of breath. When there is communication between the alveoli and the pleural space, air fills this space changing the gradient, lung collapse unit equilibrium is achieved, or the rupture is sealed. Lungs tend to collapse due to elastic recoil. When the chest wall expands outwards, the lung also expands outwards due to surface tension between the parietal and visceral pleurae. Usually, the pressure of the pleural space is negative when compared to atmospheric pressure. The pressure gradient inside the thorax changes with a pneumothorax. Pneumomediastinum has an incidence of 1 case per 10,000 admissions in the hospital. ![]() ![]() The incidence of tension pneumothorax is challenging to determine as one-third of cases in trauma centers have decompressive needle thoracostomies before reaching the hospital, and not all of these had tension pneumothorax. The incidence of iatrogenic pneumothorax is 5 per 10,000 admissions in the hospital. These occur more frequently than spontaneous pneumothorax, and their number increases as intensive care modalities advance. The leading cause of iatrogenic pneumothorax is transthoracic needle aspiration (usually for biopsies), and the second leading cause is central venous catheterization. The risk of spontaneous pneumothorax in heavy smokers is 102 times higher than in non-smokers. COPD has an incidence of 26 pneumothoraces per 100,000 patients. The incidence of SSP is 6.3 and 2 cases for men and women per 100,000 patients, respectively. Secondary spontaneous pneumothorax is seen more in old-age patients 60-65 years. The recurrence rate is highest over the first 30 days. Most recurrence occurs within the first year, and incidence ranges widely from 25% to 50%. The incidence of PSP in the United States is 7 per 100,000 men and 1 per 100,000 women per year. Primary spontaneous pneumothorax mainly occurs at 20-30 years of age. Open pneumothorax is an open wound in the chest wall through which air moves in and out. A simple pneumothorax does not shift the mediastinal structures, as does a tension pneumothorax. Pneumothoraces can be even further classified as simple, tension, or open. A traumatic pneumothorax can be the result of blunt or penetrating trauma. A primary spontaneous pneumothorax (PSP) occurs automatically without a known eliciting event, while a secondary spontaneous pneumothorax (SSP) occurs after an underlying pulmonary disease. The two subtypes of atraumatic pneumothorax are primary and secondary. There are two types of pneumothorax: traumatic and atraumatic. ![]() Air can enter the pleural space by two mechanisms, either by trauma causing communication through the chest wall or from the lung by rupture of the visceral pleura. The degree of collapse determines the clinical presentation of pneumothorax. The air accumulation can apply pressure on the lung and make it collapse. It occurs when air accumulates between the parietal and visceral pleurae inside the chest. A pneumothorax is a collection of air outside the lung but within the pleural cavity. ![]()
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