pneumothorax

Pneumothorax:

Pneumothorax refers to the collection of air/gas in pleural space, resulting from the collapse of a lung. The trapped gas puts pressure of the structures of the mediastinum

Tension pneumothorax results when any injury acts as a one-way valve, letting air enter the intact pleural space, but is not allowed to leave, or leave only more slowly than it enters. This displacement damages both the mediastinal structures (read that: heart and friends) and the lung they are pushed against

Catamenial pneumothorax is a rare type which occurs in middle-aged women, the onset within one to three days after menses

About ninety percent show chest pain, eighty percent show dyspnea. Most show anxiety and easily fatigue

Pneumothorax suffers will exhibit respiratory distress (or arrest), cyanosis, quiet or absent lung sounds, hyperresonance of the chest wall, tachycardia, (sometimes) tracheal deviation, hypotension, jugular distension, a decreased state of alertness, or distension from the pressure

locate the puncture site
prepare the site with alchol or betadine scrubs
insert a large bore angiocath (i.e. 14 gauge, except for infants, where 20 gauge is prefferable) perpendicular to the chest wall (listen for a rush of air to confirm diagnosis
remove the needle
secure and seal
prepare for a chest tube insertion

place patient in thirty to sixty degrees reverse trendelenberg position
prapare site (scrub as above)
local anesthetic (i.e. lidocaine)
make a three to four centimeter incision at the fifth rib in the midaxillary line
use a curved hemostat to puncture through the intercostals and pleura just superior to the rib border
digital exam to determine and assess pulmonary adhesion
insert clamp holding chest tube
direct tube posteriorly and insert at least five centimeters beyond the last hole
attach water vacuum
suture and secure
cover site with vaseline-covered gauze and bandage
confirm placement and lung expansion