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Pneumothorax: Springer International Publishing

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Question:

Write about the Pneumothorax for Springer International Publishing.

 

Answer:

Introduction

Pneumothorax is a condition in which there is uncoupling of lung from chest wall manifested as a result of abnormal air collection in the pleural space (Porpodis et al. 2014). It can occur as a result of trauma or can occur spontaneously. The common signs and symptoms of pneumothorax are shortness of breath and sudden onset of one-sided, sharp pain. In some cases, when there is a region of damaged tissue, the amount of air increases in the chest and a one-way valve is formed called tension pneumothorax. It can lead to serious low blood pressure and oxygen shortage. It is called collapsed lung or atelectasis. In the given case study, Mr. Leigh Richards is a 39 year old man who was admitted to the hospital after he met a high speed rally car accident hitting a tree and had left humerus fractured, subdural haematoma, left tibia and fibula and left pneumothorax. He was trapped in the car by cabin intrusion that caused pinning of his leg. The following essay deals with the understanding of the pathophysiology, pharmacology and signs and symptoms of pneumothorax through Leigh Richards’s case.

Pathophysiology of Pneumothorax

In the given case scenario, Leigh Richard was a restrained passenger in a rally car. He met an accident after the rally car hit the tree as he was driving at a high speed on a dirt road. He was trapped in the car by the cabin intrusion that resulted in pinning of the leg. The car was cut in order to free his leg and allowed for the inline extrication. After the accident, he was rushed to the emergency department in a dismantled state. The X-rays revealed that he had multiple fractures in his left humerus, tibia and fibula, small subdural hematoma and left pneumothorax. Pneumothorax in Leigh is manifested as a result of the blunt chest injury after the high speed rally car accident. The blunt trauma force that occurred due to the accident and the air might have pushed on the outer side and resulted in collapse of the lung that resulted in left pneumothorax or collapsed lung condition in Leigh.

In Leigh’s case, air in the pleural space is a result of the blunt trauma injury that caused lung collapse in him. It had resulted from a penetrating or blunt trauma to the chest wall (Kirmani and Page 2014). The accident in the case scenario might have resulted in exposed to blasts where there is no such apparent injury to the chest, however, resulted in lung tissue damage. Pneumothorax in Leigh could have occurred due to the blunt trauma injury at the ribs that might have resulted in rib fracture. The thoracic cavity space inside the chest contains the heart, lungs and major blood vessels. The pleural membrane covers the lung surface and lining of the inside chest wall. The layers are separated with the help of serous fluid that acts as a lubricant. Moreover, low pressure is maintained that does not allow the air to enter the pleural space and also there is low pressure of the bloodstream gases. The accident resulted in pneumothorax that developed in Leigh due to the entry of air into the pleural space damaging the chest wall or the lung (Aziz et al. 2016).

Tension pneumothorax is a worsened condition in which there is significant impairment of blood circulation or respiration. This condition generally occurs due to trauma where the air is leaked into the chest cavity by the lungs and result in chest compression including the vessels that return to the heart with blood (Roberts et al. 2015). Chest pain and acute respiratory distress occur in the initial stages. In clinical situations, resuscitation, ventilation or trauma takes place and in such situations, under water sealed drains (UWSDs) are inserted. These are commonly called chest drains that allow draining the blood, fluid or air from the pleural spaces so that there is proper expansion of lungs and restoration of the negative pressures in the thoracic cavity. This underwater seal also helps to prevent the fluid or gas backflow into the pleural cavity. This chest drain management is important to restore the normal respiratory function and stability. UWSDs are three chambered that consists of suction control, water seal and drainage collection.  They also aid in removing the fluid or air from the pleural cavity as well as backflow into the pleural space (Inocencio et al. 2017).

 

Signs and Symptoms

The common signs and symptoms of pneumothorax are sudden onset of chest pain, shortness of breath, rapid heart rate, rapid breathing, cough and fatigue in rare cases. Among all symptoms, acute chest pain and shortness of breath is manifested in almost 64-85% of the patients suffering from pneumothorax (Roberts et al. 2014).

When Leigh was rushed to the emergency department after the accident, he was witnessed to have shortness of breath and chest tightness. He was unable to speak and faced difficulty in speaking long sentences. He was drowsy and disoriented at the time of admission at the emergency department. This condition occurred in Leigh as the normal intrapleural pressure is revered after the blast trauma injury. Shortness of breath and chest tightness and pain are the common clinical signs and symptoms of pneumothorax (Harvey, J.J., Harvey and Belli 2016). Shortness of breath or dyspnoea occurs mainly due to the increase in pressure in the lungs that prevents the expansion of lungs during breathing. This resulted in shortness of breath and chest tightness as the two common signs and symptoms in Leigh manifested as a result of pneumothorax.

Due to the blast traumatic injury that resulted in left pneumothorax in Leigh caused shortness of breath in him. There was build up of fluid between the pleural space that is the chest wall and the lungs. The amount of fluid increased in the pleural space and that exerted pressure against the lungs that made in its collapse. This restricted the lungs from expanding leading to difficulty in breathing and shortness of breath in Leigh (McDonald Johnston and Ballard 2015).

Chest pain or tightness is Leigh was a clear manifestation of the blast traumatic chest injury. This resulted in clear, acute chest tightness in him and he was unable to speak long sentences at the time of admission at the emergency department. This chest pain or tightness occurred as he was about to breathe as there is a lot of trapped fluid in the pleural cavity and between the lungs. During inspiration, the chest pain worsens and a sharp, stabbing pain occurs at one side of the chest in Leigh (Ying et al. 2016).

Link Between Pathophysiology and Pharmacology

In the context of diagnosis and treatment, it is important to understand the pathophysiology and pharmacology of a disease and the related theory.  In the case study of Leigh, there is pathophysiological theory that is linked to pneumothorax. This occurred as there is reversal in the normal pleural pressure due to the blast trauma injury in Leigh (Mazzaferro 2015). Firstly, for the treatment, Leigh was given UWSD as it helped to drain the fluid from the pleural space and allowed to expand lungs and restore the negative pressure in the thoracic cavity (Russell, King and Coventry 2014). This underwater seal also prevented the backflow of fluid into the pleural cavity. This chest drain was inserted in him to avoid the tension pneumothorax to occur and relief him when he arrived at the emergency department.

Leigh suffered a blast trauma injury that resulted in pneumothorax and he was given the chest drainage. An ORIF surgery was performed as he had fracture on his left tibula and fibia. Two intercostals drain was inserted that was attached to the underwater sealed drains.  Moreover, the lower drain was draining serous fluid from his lung and the draining of the air was done by the other tube, however, there were only intermittent bubble from the tube. He also had neurological fluctuations which improved with time (McKnight et al. 2016).

Fentanyl was administered to him as it is an opioid analgesic that helped him to relieve pain after the surgery. The severe fracture in Leigh’s left leg might have resulted in intense pain and fentanyl relieved him from pain. This also helped to reduce the morbidity in him. It is an anti-inflammatory drug that relieves pain and inflammation.

PCA was administered to Leigh as it is a controlled analgesic after surgery. It is a good pain reliever for relieving pain in Leigh. It also prevents the risk for respiratory infection and he is able to breathe properly (Dhamrait and Tumber 2017).

IV normal saline 64mLs/hr was also given to him to maintain the osmotic pressure, electrolyte balance, fluid and control of balance. It acts as a source of electrolytes and water.

Conclusion  

Pneumothorax is the condition where there is abnormal air collection in the pleural space that causes collapse of the lung resulting from uncoupling from the chest wall. The patient, Leigh Richards was diagnosed with left pneumothorax after the blast trauma injury. The common symptoms of pneumothorax are shortness of breath and chest tightness or pain that is illustrated in Leigh. The pathophysiology and pharmacology of pneumothorax is understood through the case study of Leigh. Moreover, identifying clinical complications and pathophysiology helps to identify the efficacy of the treatment in him. Pharmacology and pathophysiology of pneumothorax is well understood through this case study and its link to the theory.  

 

References

Aziz, S.G., Patel, B.B., Ie, S.R. and Rubio, E.R., 2016. The Lung Point Sign, not Pathognomonic of a Pneumothorax. Ultrasound Quarterly, 32(3), pp.277-279.

Dhamrait, R.S. and Tumber, S.S., 2017. Anesthetic Considerations for Chest Wall Surgery. In Surgery for Chest Wall Deformities (pp. 33-45). Springer International Publishing.

Harvey, J.J., Harvey, S.C. and Belli, A., 2016. Tension pneumocephalus: the neurosurgical emergency equivalent of tension pneumothorax. BJR| case reports, p.20150127.

Inocencio, M., Childs, J., Chilstrom, M.L. and Berona, K., 2017. Ultrasound Findings in Tension Pneumothorax: A Case Report. The Journal of Emergency Medicine.

Kirmani, B.H. and Page, R.D., 2014. Pneumothorax and insertion of a chest drain. Surgery (Oxford), 32(5), pp.272-275.

Mazzaferro, E., 2015. Pneumothorax. In 40th World Small Animal Veterinary Association Congress, Bangkok, Thailand, 15-18 May, 2015. Proceedings book (pp. 525-526). World Small Animal Veterinary Association.

McDonald Johnston, A. and Ballard, M., 2015. Primary blast lung injury. American journal of respiratory and critical care medicine, 191(12), pp.1462-1463.

McKnight, B., Heckmann, N., Hill, J.R., Pannell, W.C., Mostofi, A., Omid, R. and George, F., 2016. Surgical management of midshaft clavicle nonunions is associated with a higher rate of short-term complications compared with acute fractures. Journal of Shoulder and Elbow Surgery, 25(9), pp.1412-1417.

Mojsic, B., Mandras, A., Sujica, M. and Vasiljevic, S., 2016. Pneumothorax Related to Mechanical Ventilation: Silent Enemy. Serbian Journal of Experimental and Clinical Research, 17(3), pp.267-270.

Porpodis, K., Zarogoulidis, P., Spyratos, D., Domvri, K., Kioumis, I., Angelis, N., Konoglou, M., Kolettas, A., Kessisis, G., Beleveslis, T. and Tsakiridis, K., 2014. Pneumothorax and asthma. Journal of thoracic disease, 6(1), pp.S152-S161.

Roberts, D.J., Leigh-Smith, S., Faris, P.D., Ball, C.G., Robertson, H.L., Blackmore, C., Dixon, E., Kirkpatrick, A.W., Kortbeek, J.B. and Stelfox, H.T., 2014. Clinical manifestations of tension pneumothorax: protocol for a systematic review and meta-analysis. Systematic reviews, 3(1), p.3.

Roberts, D.J., Leigh-Smith, S., Faris, P.D., Blackmore, C., Ball, C.G., Robertson, H.L., Dixon, E., James, M.T., Kirkpatrick, A.W., Kortbeek, J.B. and Stelfox, H.T., 2015. Clinical presentation of patients with tension pneumothorax: a systematic review. Annals of surgery, 261(6), pp.1068-1078.

Russell, C., King, D. and Coventry, B.J., 2014. Vascular Access Surgery. In Cardio-Thoracic, Vascular, Renal and Transplant Surgery (pp. 83-103). Springer London.

Ying, X., Wang, P., Xu, P. and Zhu, B., 2016. pneumothorax associated with acupuncture: a systematic review and analysis. Acupuncture and Related Therapies.

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