Pneumothorax for Certified Emergency Nursing (CEN)

An accumulation of air in the pleural space. This can be caused spontaneously, or from an injury. Whether open or closed, the patient is going to be experiencing some type of pleuritic chest pain and dyspnea. One of the gold signs of a pneumothorax is decreased or absent lung sounds on the affected side. The goal of treatment is to equalize the pressure.

Causes can be:

Trauma
Primary spontaneous: No active disease…Marfans, scuba diving, high altitude.
Secondary spontaneous: from a disease process such as COPD, or a bleb
Iatrogenic: From a bad central line insertion

Pathophysiology:

Air entering the pleural space can compress the lung and can cause partial or complete collapse. The pleural cavity is inherently a negative pressure environment, and this “leak” causes a loss of that negative pressure.

Clinical Presentation:

In most pneumo:

Chest pain
Dyspnea
Cough
Restlessness
Tachypnea

In tension:

The above
Signs of obstructive shock: Hypotension, cyanosis, tachycardia
JVD secondary to mediastinal shift (LATE)
Deviated trachea away from affected side
Decreased LOC as condition worsens

In Open:

The above and:
Some sort of hole!
“Sucking” sound heard with respiration
Bubbling around chest wound with exhalation

IN ALL – Markedly decreased or absent lung sounds on affected side!

Collaborative Management:

Clinical assessment: Paint a picture for a diagnosis!
Chest X-Ray
Needle decompression: 14-16g over the needle catheter, 3-6cm in length. Above the third rib, midclavicular line – affected side!
Chest tube insertion

Evaluation | Patient Monitoring | Education:

Maintain chest drainage system (separate lecture)
Maintain O2 Saturation
VS monitoring
Prep for OR if necessary (likely in traumatic open PTX).
With open PTX, or with chest tube in place, observe for development of tension PTX
We also need to watch our intubated patients. Mechanical ventilation can cause a tension PTX as well. Make sure you are collaborating with RT

Linchpins: (Key Points)

Use your eyes and ears
Needle Decomp
Chest tube
Continued monitoring

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Transcript

For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/

References:

Emergency Nurses Association. (2022). Emergency Nursing Orientation 3.0. Cambridge, MA: Elsevier, Inc.
Sheehy, S. B., Hammond, B. B., & Zimmerman, P. G. (2013). Sheehy’s manual of emergency care (Vol. 7th Edition). St. Louis, MO: Elsevier/Mosby.