Atelectasis+Pneumothorax

The major function of the lung is to inspire oxygen and excrete

carbon dioxide from the blood. The midline trachea develops into
right and left bronchus.
The right lungs have three lobes and the left lung have two lobes.
Upper Airways
• Nose
• Pharynx
Pharaynx
• (Throat), hollow, upper portion of
the airway and the digestive tract
• Subdivided into: nasopharynx,
oropharynx, laryngopharynx
Nasopharynx
Pseudostratified ciliated columnar
epithelium
Lower Airway
• Begins with true vocal cords and extends to alveoli
• Larynx
• Trachea
• Main stem bronchi
• Segmental bronchi
• Subsegmental bronchi
• Bronchioles
• Terminal bronchioles
• Respiratory bronchioles
• Alveolar ducts
• Alveolar sacs
• alveoli
Atelectasis:
• Partial or complete collapse of lungs is called atelectasis.
• May involve entire lung, a lobe, a segment, or be
subsegmental
• There are 5 mechanisms of atelectasis:
– 1) obstructive
– 2- Non-obstructive – typically due to loss of contact
between parietal and visceral pleura.
Risk factor

Anesthesia , foreign bodies in the airway, lung disease , mucous

plugging of the air way pressure caused by mass or fluid, prolong
bed rest.
Symptoms.
Trouble breathing
Pleurisy(chest pain with inspiration)
Cough
Fever
Obstructive (Resorptive) Atelectasis
• Most common type
• Results from blockage of airway
– mucous plugging, foreign body, neoplasm, or
inflammatory debris, bronchogenic carcinoma
• It is the cosequences of complete obsturction of the airway.
Non-obstructive Atelectasis

1) Passive
2) Compressive
3) Cicatrization
4) Adhesive
In these forms of atelectasis secretions are able drain up the
bronchial tree. Because there is no obstruction,
bronchoscopy is not therapeutic.
Passive (Relaxation) Atelectasis
• 2nd most common form of atelectasis
• Contact between parietal and visceral pleura is lost due to
pleural effusion or pneumothorax.
• Leads to generalized collapse.
Compressive Atelectasis
• Due to external compression of lung
• May be caused by loculated collection of pleural fluid or by
masses in chest wall, pleura.
• Similar to relaxation atelectasis but collapse is local rather
than generalized.
Adhesive Atelectasis
• Caused by adherence of the alveolar wall surfaces in the setting of
surfactant deficiency (e.g., hyaline membrane disease)
• Surfactant has phospholipid dipalmitoyl phosphatidylcholine,
which prevents lung collapse by reducing the surface tension of
the alveoli
• Lack of surfactant or inactive surfactant cause alveolar instability
and collapse
Cicatrization Atelectasis
• Secondary to fibrosis (scarring) of lung parenchyma with
subseqent lack of expansion
• Etiologies include granulomatous disease (often occurs in sarcoid,
fungal, and chronic TB), necrotizing pneumonia, and radiation.
Treatment

Re expand of the lungs , if pneumothorax or heamothorax is causing

the trouble then it need to be drained.
Purcussion of the chest, clapping the chest can mobilise mucous
plugging and allow the airway to clear.
Brochoscopy. Manually remove and moveble blockage from the
airway.
postural drainage. By changing position mucous and plugging can be
relived and thus improved the collapse the airway.
Pneumothorax
Defination

Air within the pleural cavity (i.e. between visceral and parietal
pleura)
The air enters via a defect in the visceral pleura (e.g.
ruptured) or the parietal pleura (e.g. puncture following rib
fracture)
pneumothorax may interfere with normal breathing. It is
often called collapsed lung, although that term may also
refer to atelectasis
Types
1. Primary spontanous pneumothorax.
This type of pnumothorax occure in young tall and
healthy man, which have no lung disease .
causes.
smoking, diver, flying
2. Secondry spontanous Pntx.
This type of disease occure in those who have already
lung disease like asthma, COPD, cystic fibrosis,
HIV ,TB.
3. Traumatic Pnxt.
Due to chest injury, truama the air coming inside the
lung and traumatic pnxt occur.
4. Iatrogenic pnxt.
iatrogenic pnxt is due to DR cause. during the medicaly
intervention, mechanically ventalation or during any type
of catheterizaion the the plueral cavity rupture and the air
coming inside and cause pneumothorax.
– Mediastinum remains central
– Clinical condition stable
– Can wait for CXR to confirm diagnosis
5. Tension pnxt.
– Progressive build up of air in the pleural space, causing
a shift of the heart and mediastinal structures away from
side of pneumothorax . Most serouis problum. severe
respiratory distress the pts can die .Due to tracheal
deviation and tension the respiratory and cardaic arrest
and the pts will be die.
– Clinical condition unstable
– Do not wait for CXR to confirm diagnosis
SIGN AND SYMPTOM
• Symptoms of a pneumothorax include
• chest pain that usually has a sudden onset.
• Shortness of breath(dyspnea)
• rapid heart rate,
• rapid breathing,
• cough,
• fatigue
• cyanosis due to decreases in blood oxygen levels.
• Pleuritic and purcussion hyper resonance.
DIAGNOSES
Chest X-ray
Computed tomography
Ultrasound
Management
The treatment of pneumothorax depends on a number of factors, and
may vary from discharge with early follow-up to immediate needle
decompression or insertion of a chest tube.
In traumatic pneumothorax, chest tubes are usually inserted. If
mechanical ventilation is required, the risk of tension
pneumothorax is greatly increased and the insertion of a chest
tube is mandatory.
Tension pneumothorax is usually treated with urgent needle
decompression.The needle or cannula is left in place until a chest
tube can be inserted.If tension pneumothorax leads to cardiac
arrest, needle decompression is performed as part of resuscitation
as it may restore cardiac output.
THANK YOU