NARD Diving MedicineDiving MD

Pneumothorax

Pneumo means: air; lung. Thorax is the chest cavity. Together pneumothorax means air is in the chest or pleural cavity where it is not supposed to be, outside the lungs. The most common cause of pneumothorax is trauma. When seen in a diver the rescuer must assume the cause to be air embolism. There is characteristically a sharp pain in the chest that is intensified by deep breaths. Because of this a victim will often times be tachypneic (shallow breathing in a swift manner). He may be ashen and illustrate a desire to bend toward the affected side.

When auscultating (listening) the chest, there may be a reduction, or loss of breath sounds. The amount of diminishment hinges on the extent of lung involvement. A completely collapsed lung will not generate audible sounds of breathing. Out-of-doors noise levels are high and if on a boat, engine clamor, will make hearing the lungs exceptionally difficult. To verify lung involvement, go to the back of the victim and place one hand on each side of the chest, under the arms about nipple line. Have the patient take a deep breath and feel the movement. How much the chest moves depends on the amount of lung involvement. In a totally collapsed lung the affected side will not move or only partially move in relation to the unaffected side.

Sometimes the impaired lung tissue behaves as a one-way valve, enabling gas to infiltrate the chest cavity but not withdraw. When this takes place the size of the air space in the chest expands with each breath. This malady is called TENSION PNEUMOTHORAX. In simple pneumothorax after the original leakage of gas out of the lung occurs the situation typically does not get worse, but with tension pneumothorax respiratory distress worsens with every breath and advances quickly, causing death if air is not vented.

Signs and Symptoms of Pneumothorax
Shortness of breath
Sharp Pain in Chest
Rapid Shallow Breathing
Cyanosis
Diminished or Absent Breath Sounds
Unilateral Chest Movement

Administer 100% oxygen by demand valve and let the patient assume a position of comfort. If unsure whether the victim has pneumothorax treat as such until the ER can take an X-Ray to ascertain extent and location. Pneumothorax can sometimes by concluded by tracheal deviation. At the top of the chest is a notch where the trachea descends into the chest cavity. By placing two fingers at that location and palpating (feeling) the trachea any deviation will be felt. Tension cases require immediate chest recompression that is done by opening the inner chest to atmospheric air. Some EMS's allow Paramedics to perform this by using a McSwain Dart or 14 gauge IV catheter. If you are not trained in this technique do not attempt it. Get the victim to an ER as soon as possible.

Victims of air embolism who have a pneumothorax should not delay in beginning recompression. Victims will experience relief upon recompression. A chest tube should be inserted at depth to prevent expansion of trapped gas on ascent.

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