Pleural Cavity

Pleura Parietal Pleura Pleural Cavity

The thin serous membrane around the lungs and inner walls of the chest. Pleura that lines the inner chest walls and covers the diaphragm. (Outer pleura) Has 5 !5 m". #cts as lubricant that allows the pleural surfaces to move without friction. Pleura that covers the lungs. (%nner pleura) The space in the thoracic cavity behind the sternum and in between the two pleural sacs (containing the lungs).

$isceral Pleura &ediastinum

Definition
Pneumothorax' or collapsed lung' is a potential medical emergency caused by accumulation of air or gas in the pleural cavity ' occurring as a result of disease or in(ury' or spontaneously.

Pathophysiology
The lungs are located inside the chest cavity' which is a hollow space. #ir is drawn into the lungs by the diaphragm. The pleural cavity is the region between the chest wall and the lungs. %f air enters the pleural cavity' either from the outside (open pneumothora)) or from the lung (closed pneumothora))' the lung collapses and it becomes mechanically impossible for the in(ured person to breathe' even with an open airway. %f a piece of tissue forms a one*way valve that allows air to enter the pleural cavity from the lung but not to escape' overpressure can build up with every breath+ this is ,nown as tension pneumothora). %t may lead to severe shortness of breath as well as circulatory collapse' both life*threatening conditions. This condition re-uires urgent intervention.
Motor vehicular accident Gun or Knife wound in Chest wall or Diaphragm Puncture tear in an internal respiratory structure Alveoli! "ronchus! "ronchioles #e$g$ alveolar collapse%

Open Pneumothorax

Closed Pneumothorax

Air enter pleural space a with every inhalation& and cannot escape during expiration Air enters the Pleural Space

Pneumothorax

Kinds of Pneumothorax
Open Pneumothorax Closed Pneumothorax
#ir enters pleural space to the hole #ir escapes in pleural space from a in chest wall or diaphragm. puncture or tear in an internal respiratory structure such as bronchus' bronchioles' and alveoli. Cause of surgery on the chest or trauma to the chest wall. (e.g. stab This condition over time results in a wound) gradual accumulation of air to the degree that it begins to put pressure (it allows air to enter the pleural space) on the &ediastinum' compressing the heart and decreasing cardiac output due to the reduced amount of diastolic filling of the ventricles' leading to circulatory problems.

Classification of Pneumothorax
Spontaneous
Cause is '(n)nown*

Tension

Traumatic

1ite of Pleural rapture &ay lead to lung acts as one way valve' collapse resulting permitting air to enter from either blunt form Could be result of on inspiration but trauma to chest wall another disease such preventing its escape creating of an open as COP.' PT/ and by closing up during suc,ing chest wound Cancer e)piration. cause either gun or ,nife wound' motor Chest wall is intact+ vehicle accident. blebs0bulla is rapture causing collapse lungs. (a bladder-like structure more than 5 mm in diameter with thin walls that may be full of fluid)

Clinical Manifestation
1udden shortness of breath .ry coughs Cyanosis (turning blue) Pain felt in the chest' bac, and0or arms are the main symptoms. %n penetrating chest wounds' the sound of air flowing through the puncture hole may indicate pneumothora)' hence the term 2suc,ing2 chest wound. %f untreated hypo)ia may lead to loss of consciousness and coma. %n addition' shifting of the &ediastinum away from the site of the in(ury can obstruct the superior and inferior vena cava resulting in reduced cardiac preload and decreased cardiac output. 3ntreated' a severe pneumothora) can lead to death within several minutes.

Spontaneous

Tension

Pleural pain 1evere hypo)emia Tachypnea .yspnea &ild .yspnea Hypotension P.4. $enous return is decreased (result of o 5eveal #bsent 0 decreased breath compression by the increasing pressure) sound o Hyperesonance (percussion) on the 1hoc, affected side. /radycardia

Assessment and Diagnostic findings

.yspnea Tachycardia Tachypnea 1harp chest pain Pleural Pain #bsent of breath sound .ecreased e)pansion unilaterally Cyanosis Hypotension 1uc,ing 6ound Auscultation 8ote the one part of the chest that doesn9t transmit the normal sounds of breathing. Chest +,-ay 6ill show the air poc,et and the collapsed lung and show that the To diagnose pneumothora)' it is necessary for the health care provider to7

Tracheal deviation to the unaffected trachea is being pushed to one side side with tension pneumothora) because of a collapsed lung. .lectrocardiogram #.CG% 6ill be performed to record the electrical impulses that control the heart:s activity. Arterial "lood Gases #A"Gs% /lood samples may be ta,en to chec, for the level of O; and CO; level

Treatment
# small pneumothora) may resolve on its own' but most re-uire medical treatment. The ob(ect of treatment is to remove air from the chest and allow the lung to re* e)pand. This is done by inserting a needle and syringe (if the pneumothora) is small) or chest tube through the chest wall. This allows the air to escape without allowing any air bac, in. The lung will then re*e)pand itself within a few days. 1urgery may be needed for repeat occurrences. # chest tube is placed -uic,ly or a large*bore needle is inserted into the pleural space to decompress it until a chest tube can be placed #n outward gush of air as the needle or chest tube is inserted confirms the presence of tension pneumothora) The chest tube is connected to water seal drainage and suction until the damage pleura is healed. #fter the pneumothora) is evacuated and the pleural rupture is healed' the chest tube is removed.

Chest Tube Thoracostomy

5eturns (*) pressure to the internal pleural space 5emove abnormal accumulation of air
1erves as lung while healing is ongoing.

The insertion of chest tube permits removal of the air or bloody fluid and allows re* e)pansion of the lungs and restoration of the normal negative pressure in the pleural space. /ecause air rises' a chest tube inserted to remove air is usually placed anteriorly through the ;nd %C1. # chest tube inserted to remove fluids is placed posteriorly in the < th and =th %C1 because fluid tends to flow to the bottom of the pleural space.

Chest Drainage Container

# waterseal at the end of a chest tube is essential to allow air to escape through the tube but prevent air from traveling bac, up the tube and into the pleural space. The waterseal drainage system is placed below the level of the patient9s chest' ta,ing

advantage of the force or gravity to promote drainage and prevent bac,flow of bottle contents into the pleural space.