![]() ![]() Chest pain is usually severe, sharp/stabbing, pleuritic and radiates to ipsilateral shoulder/arm. The most common presenting symptoms are chest pain and shortness of breath (64 to 85%). Some patients may be asymptomatic, and pneumothorax is diagnosed as an incidental finding during the workup for another condition. The clinical presentation varies depending on the etiology and the size of the pneumothorax. It occurs when a chest injury causes a one-valve situation when the air gets into the pleural cavity but is unable to escape freely and thus gets trapped. Tension - progressive accumulation of air in the pleural cavity causing the shift of mediastinum to the opposite side, resulting in compression of vena cava and other great vessels, decreased diastolic filling, and ultimately compromised cardiac output. This loss of the chest wall integrity can create an air sucking and a paradoxical lung collapse, thus causing significant ventilatory problems.ģ. Communicating - when there is a defect in a chest wall, such as from a gunshot wound, that causes open communication with an outside atmosphere. An example is a pleural laceration from a fractured rib.Ģ. Simple - when the air in the pleural space does not communicate with an outside atmosphere, and there is no shift in mediastinum or hemidiaphragm. Pneumothorax can also be classified based on their physiology into the following types:ġ. Spontaneous - a pneumothorax without any apparent cause or inciting event. Iatrogenic - caused by manipulation by a healthcare provider, such as the insertion of central lines, etcģ. Majority of all pneumothoraces are traumatic in originĢ. Traumatic - resulting from blunt or penetrating chest trauma. Pneumothorax can subdivide into three broad categories according to the etiology:ġ. Our results suggest that the fiberoptic bronchoscopy is more reliable than chest auscultation in confirming ETT position.Pneumothorax - is an accumulation of air or gas in the pleural space (the space between visceral and parietal pleura of the chest cavity), which can impair with ventilation, oxygenation, or both. This condition can vary in its presentation from asymptomatic to life-threatening. Therefore, the ETT tip should be withdrawn at least 1.5 or 3.2 cm if breath sounds from the left side of the chest change or disappear, respectively, after intubation and during anesthesia. Breath sounds disappeared when the cuff was advanced about 0.7 cm into the intubated bronchus, possibly because of interruption of gas supply to the opposite bronchus. Taking into consideration these structural features, it was presumed that breath sounds changed when the proximal end of the bevel was advanced about 0.5 cm into the right mainstem bronchus, perhaps because of gas flow through the narrow space between the ETT and the bronchus. The ETT used in this study, Portex Blue Line Tracheal Tube (ID 7.5 mm), had a cuff 2.5 cm from the tip, a 1.0-cm bevel facing to the left, and no Murphy's eye. The ETT tip advanced beyond the carina invariably entered the right mainstem bronchus at 30.1 plus/minus 1.3 and 31.9 plus/minus 1.0 cm from the nares at change and disappearance of breath sounds, respectively. The carina was 28.7 plus/minus 1.2 cm from the nares in females who averaged 156 plus/minus 7 cm in height. ![]()
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