Paper Example on Pneumothorax: Chest Pain, Dyspnea, Injury, & Disease

Introduction

Pneumothorax is according to Zarogoulidis et al. (2014), refers to a health condition where the air, as well as other gases, exists in the pleural cavity and happens spontaneously particularly as a result of injury or disease on lung tissues, chest wall puncture, or rupture of air-filled pulmonary and it can also be introduced as a therapeutic measure aimed at collapsing the lungs. It is characterized by chest pain and dyspnea such as those originating from the chest wall and lungs and may interfere with the regular respiration due to gas retention and gas bubbles present in pleural space and pleural cavity respectively after the bullae ruptures. In a healthy individual, the pleural pressure is adverse with respect to pressure of the atmosphere throughout the whole cycle of respiratory (Choi, 2014). Thus, the pressure variance between the pleural cavity and the pulmonary alveoli results to stirs of some elastic lung recoil (Iribarren, Prolo, Neagos & Chiappelli, 2005). However, in pneumothorax, the pulmonary alveoli or the airway is associated with the pleural cavity. As a result, air moves to the pleural cavity from the alveoli continuously until both areas achieve an equilibrium pressure. Also, when the chest wall together with the pleural cavity are linked, air from the environment finds its way to the pleural cavity till the link is sealed or there is equilibrium in pressure.

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Etiology

The primary causes of pneumothorax are classified as either primary or secondary spontaneous as well as traumatic.

Primary Spontaneous

It is abbreviated as PSP and occurs when there is an absence of known lung disease. However, the actual cause of PSP has not been established but there as factors which are attributed to causing it. For instance, family history or pneumothorax, male sex, and smoking (Iribarren, Prolo, Neagos & Chiappelli, 2005). In most cases, it occurs among young adults but also can affect older adults in the absence of underlying lung problems. Its major symptoms which are usually experienced are mild breathlessness and chest pains (Tamminen, 2014). There are some instances that it may pose a threat to the life of a patient, but some may wait for days before visiting an infirmary to seek medical attention.

Secondary spontaneous

It occurs from an underlying chest illness. In most cases, it is observed among patients suffering from COPD which accounts for approximately 70% of its occurrence (Zarogoulidis et al., 2014). There are other recognized ailments which may escalate its occurrence such as lung cancer, cystic fibrosis, necrotizing pneumonia, asthma, idiopathic pulmonary fibrosis, and tuberculosis, among others (Choi, 2014). Some of the symptoms associated with secondary spontaneous include hypercapnia and hypoxemia in severe instances. However, there should be urgent medical investigation for unexpected start of breathlessness particularly those with recognized core lung ailments such as cystic fibrosis and COPD among other severe lung sicknesses to determine the likelihood of a pneumothorax.

Traumatic pneumothorax

It can be categorized either as iatrogenic or non-iatrogenic traumatic pneumothorax. Non-iatrogenic pneumothorax takes place if the chest wall is pierced or wounded, for example, when a gunshot or stab would permit air to make its way in the pleural space while iathrogenic trauma is caused by alveolar rapture. It has been discovered that in approximately half of instances of chest trauma only rib fractures are common. Remarkably, traumatic pneumothorax has been evident in patients, particularly those undergoing mechanical ventilation for different reasons.

Tension Pneumothorax

It emerges when there is a interruption that encompasses the tracheobronchial tree, parietal pleura, or pleura. It takes place when one there is formation of one valve which permits air to flow inwards to the pleural space while the air outflow is prohibited at the same time. The non-absorbable interapleaural air volume escalates with every inhalation which causes pressure to rise particularly within the infected hemithorax. More pressure results to mediastinum shifting towards the contralateral lung as well as the contralateral side where its compresses both sides as shown in figure below.

Clinical Manifestation and Diagnosis

It can be complicated to diagnose pneumothorax because of its different causes and symptoms. In non-emergency situations, medical practitioners will first conduct a physical examination on an individual to observe for signs and symptoms of the ailment (Badillo & Francis, 2014). For instance, doctors may tap on the patient's chest to assess the presence of any abnormal sounds. They may also tap to listen through a stethoscope on how one is breathing. They may also inquire about patient's habits, for example, smoking as well as their previous medical history. Doctors can also inquire about social and family history, particularly on lung-related diseases such as tuberculosis (Zarogoulidis et al., 2014).

Conversely, lab tests can also be undertaken as a pneumothorax diagnosis. One of the most significant approach is imaging. This is done by using x-rays where chest images are taken, and signs of collapsed lungs are assessed. An x-ray is taken as the patient inhales fully while holding his or her breath. Ultimately, the magnitude of pneumothorax is measured as the distance between the chest was and the lung, to determine the size of pneumothorax as shown in the figure above. These distances also influence how pneumothorax is treated (Badillo & Francis, 2014). However, CT scans may be utilized to obtain better images compared to those obtained from x-rays. They are always used, particularly in trauma cases when doctors require highly accurate pictures of puncture wound among other damages for immediate medical intervention of the patient (Zarogoulidis et al., 2014).

Treatment

They type of treatment for pneumothorax relies on various issues and may differ from discharge ranging from early follow-up stretching to urgent insertion of chest tubes (Huang et al., 2014). It also varies depending on the doctor attending the patient, and for instance, thoracic surgeons utilize two ports and a surgery suite while pulmonary physicians normally conduct medical thoracoscopy. Nonetheless, in most cases, patients are consulted to know their preference. For instance, in the treatment of traumatic pneumothorax, thoracic surgeons handle the patients since other chest organs may be affected as the chest tubes are being inserted. Where the mechanical ventilation is needed, tension pneumothorax risk is significantly escalated, and chest tube insertion becomes mandatory. It is also required that any chest wound be sealed with an airtight cover.

Conversely, spontaneous pneumothorax has various treatment strategies. For instance, oxygen therapy where gas present in the pleural cavity is drained through diffusion and can also be aided by altering the composition of gas present in the intra-pleural cavity (Huang et al., 2014). Another treatment approach is observation, which is undertaken for both primary and secondary spontaneous pneumothorax where stable patients are assessed as the gas is passively absorbed from the pleural cavity (Zarogoulidis et al., 2014). Simple aspiration can also be used to treat spontaneous pneumothorax where there is the insertion of a catheter directly to the pleural cavity (Huang et al., 2014). It may be left inserted or removed immediately after the air has been evacuated as the patient is continuously observed.

Case Study

The patient in this case is called Pt, a 52-year-old pleasant male who a month ago was involved in a car accident, and gone through an open lung biopsy. However, after the accident, he was rushed to the nearest hospital which was within his locality where he received some treatment. He was released and went home from where he received a follow up from the doctor office. However, after a couple of days, he called the doctor's office and informed him that he experienced difficulty in breathing which the doctor referred to as shortness of breath (SOB). He also stated that he had been coughing persistently for 3-4 days, particularly when he experienced SOB. After listening to Pt condition, the doctor recommended him to visit the hospital premise after booking him an appointment to receive a chest x-ray.

Pt availed himself as the booked date for his appointment. However, from his physical examination, Pt appeared alert, awake, and well-nourished and one could not notice any respiratory issues facing him. Upon conducting a further physical examination, it was discovered that he had a weight of 232lbs, which is equivalent to 105.4 kgs and a height of 6.3 feet(190.5cm). Physical examination was also undertaken on the vitals where it was discovered that he had a temperature of 97.5F, respiratory rate of 16 breaths per minute, a heart rate of 72 beats per minute, and a normal blood pressure of 138/94mmHg. His peripheral capillary oxygen saturation abbreviated as SpO2 was also found normal since it was estimated by 96%. Therefore, with these results from the physical examinations particularly on the vitals, it was concluded that he was afebrile that is no fever, eupneic meaning he had a normal rate of breath, and pre-hypertensive from since his blood pressure ranged within the normal rate.

Since from the physical examination, no exact ailment or issue could be noticed, it was essential to assess his past medical, surgical, family, and social history (Tamminen, 2014). However, from his past medical history, he stated that he had suffered from Dyspnea, chronic obstructive pulmonary disease abbreviated as COPD, and Gastroesophageal reflux disease (GERD), and lung disorder. He also stated that he had Arthritis, Usual interstitial pneumonia, Pulmonary Fibrosis, and post-traumatic stress illness, which he denoted to as PTSD. On the other hand, he had received hand surgery, and lung biopsy referred to as video-assisted thoracotomy, which is the minimally invasive surgical method utilized particularly in the diagnosis and in treating chest problems. However, he stated that he had no allergy known to him. On family history, he stated that his grandfather suffered from coronary artery sickness, his mother suffered from both coronary artery ailment and heart illness while his brother had liver cancer and hepatitis C. He also stated from his social history that he smoked three and a half packets of cigarettes daily since the age of 18. This totaled to a total of 119 packs in a year. Nonetheless, he denied smoking smokeless tobacco, drinking alcohol, or using any other drug.

The review of the system was undertaken to identify possible illness which Pt experienced. In general, it was discovered that he was positive for activity change and fatigue, but he had no fever. Examination conducted on his respiratory system revealed that he tested positive for cough and chest tightness, but he was negative for leg swelling and palpitation, which refers to a rapid, strong, and irregular heartbeat. It was also discovered that on the cardiovascular system, he was positive for chest pain. However, the reviews on all other system were negative. This led to the conclusion of possible diseases he might be suffering from which were distinguished as flu, bronchitis, asthma, pneumonia, cold, and pneumothorax. Nevertheless, to be ascertained of the specific ailment, lab studies were ordered.

The most significant lab test conducted on Pt was a blood test and chest x-ray. It was established that he has a white blood cells count of 12 10C9/L and hemoglobin count of 15.6g/dL while hematocrit and platelet count were 46.1% and 285 10E9/L respectively. Tests on nutrients level were discovered as sodium 138mmol/L, potassium 3.6mmol/L, chlor...