Case Study Pneumothorax

Case Study: Pneumothorax (See related pages)

Pneumothorax Case Presentation John, a healthy twenty-eight year old electrical engineer, was driving home from work one evening when he experienced sudden stabbing pain in his right pectoral and right lateral axillary regions. He began to feel out of breath and both his respiratory rate and heart rate increased dramatically. As luck would have it, John passed a hospital each day on his way home and was able to get himself to the hospital’s emergency room. The emergency room physician listened to John's breathing with a stethoscope and requested blood gas analysis and a chest x-ray. John answered a few of the doctor's questions. The doctor noted that John had no history of respiratory problems but was a heavy smoker. After viewing the chest radiograph, the doctor informed John that he had experienced a spontaneous pneumothorax, or what is commonly called a collapsed lung. The doctor explained that a hole had opened in John's right lung and that this hole had allowed air to leak into the cavity surrounding the lung. Then, as a result of the lung's own elastic nature, the lung had collapsed. The doctor said he could not be certain of the cause of the pneumothorax, but smoking cigarettes had certainly increased the likelihood of it happening. He told John he was fortunate the pneumothorax was small, which meant that relatively little air had escaped from the lung into the surrounding cavity, and it should heal on its own. He instructed John to quit smoking, avoid high altitudes, flying in nonpressurized aircraft, and scuba diving. He also had John make an appointment for a re-check and another chest x-ray. Case Background Spontaneous pneumothorax occurs when a blister on the surface of the lung opens, allowing air from the lung to move into the pleural cavity. This occurs because alveolar pressure is normally greater than the pressure in the pleural cavity. As air escapes from the lung, the lung tissues will recoil, and the lung will begin to collapse. The lung will continue to collapse until the difference between the alveolar pressure and pleural pressure disappears or until the collapsing of the lung causes the opening to seal. The pneumothorax decreases the efficiency of the respiratory

system, which in turn results in decreased blood oxygen concentration, increased respiratory rate, and increased heart rate. If the pneumothorax is small, the air that escapes into the pleural cavity can be reabsorbed into the lung once the opening has sealed shut. If the pneumothorax is large, a needle or chest tube may have to be inserted into the pleural cavity to draw the air out and allow for the reexpansion of the lung.

Define the following terms and explain how they may have been affected by John’s spontaneous pneumothorax.

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Visceral pleura

Parietal pleura

Pleural cavity

As a result of a pneumothorax, the lung tissues recoil, and the lung collapse in a healthy lung?

How does elastic recoil function in breathing?

Why was John instructed to avoid high altitudes and flying in nonpressurize

The Patient 73 Year Old Male 145 lbs. NKA Full Code Admitted for: 1. Right-sided pain of the thorax and upper arm 2. Four centimeter scalp laceration

History of Present Condition

Patient sustained a 10 foot fall Diagnosed as having: 1. Right-sided pneumothorax 2. Right sided fractured ribs 3. Right-sided sternoclavicular joint dislocation 4. Four centimeter scalp laceration.

Immediate Course of Action: Day #1 Patient came in to the ED following a fall. He was subject to chest x-rays, CT s spine), as well as an MRI (lumbar, thoracic, and cervical spine). As stated ab pneumothorax, multiple rib fractures, and a sternoclavicular joint dislocation.

To treat the pneumothorax he had a chest tube inserted with 20cm dry suc endured no complications as a result of this procedure.

To treat the dislocated joint he had his arm placed in a sling to stabilize the The scalp laceration was closed with staples.

For his pain the patient had a thoracic epidural placed (10mg Dilaudid, 2m

Course of Action: Day #2 Patient received another chest x-ray to monitor the

tatus of the chest tube placement and pneumothorax. Results showed that the rig atrial fibrillation with rapid ventricular response. He was placed on a Cardizem SBP greater than 90.

Course of Action: Day #3 Patient received another chest x-ray to monito pneumothorax. Results showed that the right lung remained fully expanded. He 2200.

Course of Action: Day #4 Patient received another chest x-ray to monitor the pneumothorax. Results showed that the right lung remained fully expanded, how suggestive of pneumonia. Patient was placed on Levaquin (750mg every 24 hours

Course of Action: Day #5-10 Patient's lung remains reexpanded. Copious am system. He also completed his round of IV antibiotics for the pneumonia. Course of Action: Day #11 Patient's chest tube removed as well as the staples

Course of Action: Day #12 Patient was dismissed home. Went home with slin joint.

Pathophysiology

A pneumothorax occurs when air enters the pleural space between the visceral pl complete lung collapse.

Signs & Symptoms: Mediastinal shifting usually occurring with distant to absent breath sounds on th

Sudden onset of acute pleuritic chest pain on the affected side usually occurs with

Other problems that may occur include uneven chest wall movement, tachycardia

Past Medical History - Hypothyroidism - History of duodenal stricture - No history of smoking or drinking

Assessment Findings

0800: VS- 97.7/100/16, BP 128/76 in left arm, O2 sat 93%. Pt. alert, oriented x3. diffuse over right lateral thorax. MM moist, pink, intact. Nail beds pale pink, 60min, do not bolus or infuse too rap Reason: Community-acquired pneumonia Classification: Broad-spectrum fluoroquinolone antibiotic Actions: Inhibits bacterial DNA replication, transcription, repair, and recombina Side effects: Decreased vision, foreign body sensation, transient ocular burning, o phlebitis.

Levalbuterol (Xopenex) 1.25mg TID IH Administration: Nebulizer treatment Reason: Reversal of bronchospasm with reversible obstructive airway disease. In Actions: Acts on the beta2 receptors of the smooth muscles of the bronchial tree, Classification: Beta-adrenergic agonist Side effects: Migraine, tachycardia, increased serum glucose, dyspepsia, increase

Diltiazem (Cardizem) 240mg Daily PO Administration: Do NOT crush, withhold if SBP