Pneumothorax.pptx

Pneumothorax and Physitherapy treatment

1. Pneumothorax : Physiotherapy Assessment Include Goals And Treatment Ms. Shilpasree Saha BPT, MPT (Cardio Thoracic Disorders) MIAP

2. Pneumothorax A pneumothorax is a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and visceral pleurae inside the chest. The air accumulation can apply pressure on the lung and make it collapse. 

3.  Air can enter the pleural space by two mechanisms, either by trauma causing communication through the chest wall or from the lung by rupture of the visceral pleura.

4. Pneumothorax : Traumatic Atraumatic /Spontaneous Primary Secondary

5.  A primary spontaneous pneumothorax (PSP) occurs automatically without a known eliciting event, while a secondary spontaneous pneumothorax (SSP) occurs after an underlying pulmonary disease. A traumatic pneumothorax can be the result of blunt or penetrating trauma.

6. A simple pneumothorax does not shift the mediastinal structures, as does a tension pneumothorax . Open pneumothorax is an open wound in the chest wall through which air moves in and out.

7. Aetiology Rupture of a pleural bleb in the region of apex of lung.

8.   Computed tomography  (CT) showing blebs. C hest x-ray showing pneumothorax with blebs .

9. II. Rupture of emphysematous bulla. III. Rupture of lung abscess or tuberculosis lesion into pleural cavity.

10. a  The chest radiography image shows a large lucency occupying the right upper thorax with mediastinal shift and patchy opacities of the left apical area.  b  The coronal computed tomography image shows giant bullae occupying the right thorax and multiple opacities over the left upper lung

11. Other causes Penetrating rib fracture Penetrating wounds Accidental opening of pleural cavity during abdominal surgery Penetration of pleura during central venous pressure catheter insertion.

12. Physical findings The most common symptoms are: Chest pain Shortness of breath. The chest pain is pleuritic , sharp, severe, and radiates to the ipsilateral shoulder. 

13. On examination, the following findings are noted: Diminished chest movement Absence of breath sound over apex of effected lung. Respiratory discomfort Increased respiratory rate Asymmetrical lung expansion Decreased tactile fremitus   Hyper resonant percussion note Decreased intensity of breath sounds or absent breath sounds

14. In tension pneumothorax following additional findings are seen: Tachycardia of more than 134 beats per minute Hypotension Jugular venous distension Cyanosis Respiratory failure Cardiac arrest

15. Treatment A small pneumothorax requires few days of bed rest until it resolves. A large pneumothorax (›25 percent of pleural space is filled with air) is treated with needle aspiration or by an intercostal drain. Pleurodesis or pleurectomy may indicated for recurrent pneumothorax .

16. PT-Treatment Expansion breathing exercise to reexpand the lung. Shoulder ROM exercises to maintain shoulder, shoulder girdle and thoracic mobility