Pneumothorax is a potentially life-threatening condition characterised by the presence of air in the pleural space. Paramedics are required to diagnose a pneumothorax quickly and manage it immediately. This article aims to provide a comprehensive understanding to the reader on the topic of pneumothorax pathophysiology, the signs, and symptoms to recognise and how it should be treated.
Pathophysiology:
A pneumothorax occurs when air enters pleural space (the space between the lung and the chest wall), this then leads to the pressure build-up resulting in a collapsed lung. The multiple types of pneumothoraxes, the most common being spontaneous, traumatic and tension pneumothorax. A spontaneous pneumothorax occurs without trauma and is broken down into primary and secondary spontaneous pneumothorax. Primary spontaneous pneumothorax occurs when alveoli rupture, a potential result of small blebs (air-filled sacs) on the lung surface bursting, releasing gas into the pleural space. Secondary spontaneous pneumothorax occurs because of diseases such as COPD, asthma, cystic fibrosis, and many others weakening lung tissue, making it more prone to rupture and leak air into the pleural space. Traumatic pneumothorax is a result of blunt or penetrating force trauma. This type of pneumothorax is more commonly seen in car accidents, falls, gunshot wounds, etc. Tension pneumothorax develops just like the other types, where air enters the pleural space, what differentiates it, is that air continues to enter the pleural space during inspiration, but does not exit during expiration, therefore, resulting in pressure increasing every time a patient breaths in. As the pressure rises, it compresses the collapsed lung, major blood vessels and the heart, impairing all function of the affected organs and threatening the patient with cardiovascular collapse.
Signs and Symptoms:
Depending on the size and how rapidly the air has accumulated in the pleural space will depend on the severity of the following manifestations:
- Sudden onset sharp chest pain
- Shortness of breath
- Tachypnoea (rapid breathing)
- Decreased or absent breath sounds during auscultation
- Cyanosis
- Anxiety
- Chest wall tenderness
Treatment:
As a paramedic it is important to recognise a pneumothorax quickly, doing this will allow immediate treatment and relief for the patient. Post recognition of pneumothorax, it is best to needle decompress; doing this will release the air trapped in the pleural space, once decompressed, leave the needles in until the patient has reached the hospital, the nurses will then consider administering a chest tube. Consider pain management, if there is time pre-needle decompression for pain management medication then administer it, primary focus is relieving the air in that pleural space though so consider this post-procedure. Continue to observe patient vital signs, provide supplementary oxygen when needed and transport to the appropriate hospital for patient care. When encountering a patient with a pneumothorax, stabilise the patient first then consider other management options as the patient's life and well-being comes first.
In conclusion, pneumothorax is a common condition witnessed in the medical field, especially in car accidents and falls. Clinicians must familiarise themselves with pathophysiology, assessment techniques, stabilisation measures, treatment and transport procedures. By honing skills for recognising a pneumothorax, clinicians will be optimally equipped to handle such a serious medical emergency.
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