Pneumothorax

Collapse of a lung from air in the pleural space

Definition

A pneumothorax is the presence of air in the pleural space, which disrupts negative pressure and causes lung collapse.

Types

Spontaneous: Ruptured bleb in tall, thin, young men.
Traumatic: Blunt or penetrating chest injury.
Iatrogenic: Central line placement, lung biopsy, mechanical ventilation.
Tension pneumothorax: One-way valve traps air, compresses mediastinum. Emergency!

Signs and Symptoms

Sudden sharp pleuritic chest pain, dyspnea, tachypnea, decreased/absent breath sounds on affected side, hyperresonance on percussion, tachycardia. Tension pneumothorax: tracheal DEVIATION AWAY from affected side, JVD, cardiovascular collapse, severe respiratory distress.

Nursing Interventions

Administer oxygen, position upright, prepare for chest tube. Small simple pneumothorax may be observed. Tension pneumothorax: IMMEDIATE needle decompression (2nd intercostal space, midclavicular line), followed by chest tube.

NCLEX Relevance

Tracheal deviation + absent breath sounds + hypotension = tension pneumothorax emergency.