IV. PATHOPHYSIOLOGY 1.

Schematic diagram Book Based Pathophysiology: Non Modifiable / Predisposing Factors • Age especially infants • Immunocompromised • Common Colds Any Chest Injury Precipitating/Modifiable factors • Environment • Exposure to Pathologic Microorganism • aspiration of foods or fluids • Lung Disease • • Injury/accidents Smoking

Allows air to enter the pleural space

Manifestations: Depends on its size and the integrity of the underlying lung.

Penetration into the pleural space by an object external to the chest wall (such ash knife/needle) Open Pneumothorax

Pneumothorax
Internal Mechanism (such as broken rib or bleb rupture of the lung) air or blood enters the pleural space.

Increase intrathoracic pressure and reduction in vital capacity

Large Pneumothorax Penetrating /Non penetrating injuries Injury to the chest or respiratory structures Hypoxemia Vasoconstriction of the blood vessels in the affected lung.

Closed Pneumothorax

Air filled bleb/blister on the lung surface ruptures

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Fractured/ dislocated ribs that penetrates the pleura

Chest Trauma

Other Complication Hemothorax

Medical Procedure such as intra thoracic needle aspirations, intubation, and positive pressure ventilation

Cardio pulmonary resuscitation (CPR)

Air enters the pleural space but does not leave Rapid increase of pressure in chest with compression atelectasis of unaffected lung

Manifestations: • Ipsilateral chest pain • Inc. in RR • Dyspnea • Inc. HR • Asymmetry of chest • Hyperresonant sound upon percussion • Breath sounds decreased/absent over the area of the pneumothorax.

Spontaneous Pneumothorax

Traumatic Pneumothorax

Shift in mediastinum to the opposite side of the chest and compression of the vena cava with impairment of venous return to the heart Intrapleural pressure exceeds atmospheric pressure.

Unknown cause Air filled blebs rupture on TOP of the lungs.

Lung Disease Trapping of gases & Destruction of lung tissue Secondary Spontaneous Pneumothorax

History of endometriosis Air may gain access to the peritoneal Cavity during menstruation and then enter the pleural cavity through diaphragmatic Defect. Catamenial Pneumothorax 35

Tension Pneumothorax

Primary Spontaneous Pneumothorax

Manifestations: • Structures in the mediastinal space shift toward the opposite side of the chest. • Distention of neck veins • Intrapleural pressure Subcutaneous emphysema exceeds atmospheric Clinical signs of shock • pressure.

Partial/total loss of lung function Hypoxemia Life threatening