PNEUMOTHORAX

&
HAEMOTHORAX

NRS412
RESPIRATORY NURSING
 Group member’s :
1) NORHAZIRAH BINTI HASSAN
2022666584

2) NUR NABIHA BT AHMAD

NURI 2022219978

3) HALIMAH BINTI OMAR

2022608854

Presentation title
 PNEUMOTHORAX

Definition:
Pneumothorax is an abnormal collection of air or gas in
the pleural space separating the lung from the chest wall
which may interfere with normal breathing, causing the
lungs to collapse.
 Classification of Pneumothorax
1. Spontaneous/Simple pneumothorax :
• Primary: it occurs in young 2. •Traumatic
Open: penetrating
pneumothorax:
trauma- chest
healthy individuals without wall is damaged by any wound-
underlying lung disease. It is outside air enters pleural space
due to rupture of apical sub- and causes lungs to collapse.
pleural bleb. • Closed: blunt trauma- chest wall
• Secondary: occurs in the is punctured of air leaks from a
presence of pre-existing lung ruptured bronchus.
pathology. Ex: cystic lung
disease, COPD, Lung cancer • Iatrogenic: postoperative
and Tuberculosis(TB). mechanical ventilation,
thoracocentesis and central
. venous cannulation
3. Tension pneumothorax:
• Occurs when there is a one-way valve
that allows air to enter the pleural space
but not exit.
• Increased intrathoracic pressure and
near collapse of the lung.
• As the volume of air increases within
the pleural space, it can exert pressure
on the heart and vasculature.
• The increased intrathoracic pressure
can lead to compromise of venous
return, which can negatively impact
stroke volume, cardiac output, and
blood pressure.
• It may be a complication of other types
of pneumothorax.
• Life threatening condition-obstructive
shock
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 Clinical features:

• Dyspnea: mild to severe (pulmonary compression)

• Pleuritic chest pain: pain worse on deep inspiration.
Usually unilateral
• Reduced chest expansion
• Reduced/absent breath sounds (affected side)
• Hyperresonant percussion
• Cyanosis
• Tracheal deviation: away from the side of the
pneumothorax (late sign)
• Shock ( hypotension & tachycardia)
Pneumothorax Diagnosis
1. Chest X-Ray
• The chest x-ray may show decreased lung markings extending to the chest wall, and
the lung border may be visible.
https://www.radiologymasterclass.co.uk/gallery/chest/pneumoth
orax/pneumothorax_a

This chest X-ray shows a large pneumothorax which is
>2 cm depth at the level of the hilum.
• The left lung is completely compressed (arrowheads).
• The trachea is pushed to the right (arrow)
• The heart is shifted to the contralateral side - note right heart border
is pushed to the right (red line)
• The left hemidiaphragm is depressed (orange line)
2. CT Scan
• A CT can be more accurate than a chest x-ray, especially for diagnosing a small
pneumothorax.
• A CT scan may also be necessary to better evaluate underlying lung pathology.

Note that air density (black) is the same inside and

outside the chest
Red area = Pneumothorax
Curved arrow = Compressed lung segment
3. Ultrasound
• The absence of lung sliding on ultrasound could indicate a pneumothorax.
• When ultrasound is on M-mode, a normal lung will have a “sandy beach”
appearance whereas a pneumothorax may have a “bar-code” sign.
Treatment/Management

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 HAEMOTHORAX

Definition: medical term for a condition in which there

is presence of significant amount of blood in the
pleural space, the area between the lungs and chest
wall.

Massive Haemothorax is defined as blood drainage

≥1500ml after closed thoracostomy and continuous
bleeding at 200ml/hour for at least 3 to 4 hours
 Classification of Haemothorax:

Trauma : Spontaneous( Medical) : Iatrogenic :

• Penetrating • CVC in
• Pulmonary Embolism subclavian/jugular
• Non-penetrating
(blunt injury)- • Ruptured Aortic vein
continuing Aneurysm • thoracostomy tube
bleeding from torn • Malignant pleural placement
intercostal vessel, disease- Sarcoma, • trans lumbar
fractures of the HCC
ribs aortography
• pleural biopsy

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 Clinical Features:

• Pleuritic chest pain

• Asymmetrical chest movement with respiration ( affected side)
• Rapid, shallow breathing
• Dyspnea
• Decrease or absent of breath sounds on the affected side
• Percussion- Dullness at the affected side
• Hypotension (due to blood loss)
• Tachycardia (rapid heart rate)
• Pale or blue skin caused by lack of oxygen
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• Tracheal deviation (massive haemothorax)
Haemothorax diagnosis:

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1. CXR
Chest radiographic appearance of a large hemothorax may be similar to that of a pleural effusion. It can be
almost impossible to differentiate a hemothorax from other causes of pleural effusions.
2. CT SCAN
• CT is useful in determining the nature of the pleural fluid in the setting of trauma
by assessing the attenuation value.
• Pleural fluid attenuation measurement should be routine in the interpretation of
chest trauma CT to distinguish simple fluid from acute blood.

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3. Ultrasound
• Following trauma, a haemothorax can
be identified as a free fluid collection
(non-echogenic, black area)
• Over time, the ‘haematocrit sign’ may
also be present, where a bilayer effect
is demonstrated secondary to the
The hematocrit sign refers to the echogenic layering of
gravitational effect of the cellular material in a pleural effusion. This can be due to
components within the effusion. exudative effusions or a hemothorax .
• The extended focused assessment with
sonography for trauma (eFAST) scan
may detect smaller haemothoraces (as
little as 20mL) than a chest
radiograph. The traditional (non-
extended) FAST scan does not assess
the thoracic cavities.

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Management/Treatment
Needle Thoracostomy
&
Chest Tube

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Presentation title 27
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 Nursing intervention for patient
Pneumothorax & Haemothorax

• Improving Breathing Pattern

• Promoting Effective Gas Exchange
• Managing Pain and Discomfort
• Preventing Respiratory Trauma and Infection
• Providing Patient Education & Health Teachings

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Thank you