Pneumothorax

High concns of aluminum oxide dust can cause various types of lung damage such as Shaver s disease, fibrosis, emphysema and pneumothorax Refs 1) Gmelin, Syst Nr 35, Ted B (1934),... 

It was emphasized that any thoracic penetration may result in acute life-threatening injuries such as tension pneumothorax, hemothorax, massive cardiac injury with tamponade, great vessel injury, hemoptysis, and lung coUapse. Thermoset mbber bullets can also cause serious injuries, as shown in Figure 7.2. 

Non-cardiac Anemia, anxiety disorders, carbon monoxide poisoning, cocaine use, esophageal reflux, peptic ulcer, pleuritis, pneumonia, pneumothorax, pulmonary embolus, pulmonary hypertension, thyrotoxicosis... 

Early restrictive lung disease Infection Pneumothorax Pulmonary edema Pulmonary embolism Tissue hypoxia Burn injury Excessive mechanical ventilation Fever... 

Profound bilateral upper lobe infiltrates with cavitation on left small left pneumothorax Clinical Course... 

Central PN refers to the administration of PN via a large central vein, and the catheter tip must be positioned in the vena cava. Central PN allows the infusion of a highly concentrated, hypertonic nutrient admixture. The typical osmolarity of a central PN admixture is about 1500 to 2000 mOsm/L. Central veins have much higher blood flow, and the PN admixture is diluted rapidly on infusion, so phlebitis is usually not a concern. Patients who require PN administration for longer periods of time (greater than 7 days) should receive central PN. One limitation of central PN is the need for placement of a central venous catheter and an x-ray to confirm placement of the catheter tip. Central venous catheter placement may be associated with complications, including pneumothorax, arterial injury, air embolus, venous thrombosis, infection, chylothorax, and brachial plexus injury.1,20... 

Mechanical complications of PN are related to catheter placement and the system and equipment used to administer PN. A central venous catheter must be placed by a trained professional, and risks associated with placement include pneumothorax, arterial puncture, bleeding, hematoma formation, venous thrombosis, and air embolism.1,20 Over time, the catheter may require replacement. Problems with the equipment include malfunctions of the infusion pump, intravenous tubing sets, and filters. 

Pneumothorax The presence of air in the pleural cavity, often causing part of the lung to collapse. 

The entry of air into the pleural cavity is referred to as a pneumothorax. This may occur spontaneously when a "leak" develops on the surface of the lung, allowing air to escape from the airways into pleural space. It may also result from a physical trauma that causes penetration of the chest wall so that air enters pleural space from the atmosphere. In either case, the pleural cavity is no longer a closed space and the pressure within it equilibrates with the atmospheric pressure (0 cmH20). As a result, the transpulmonary pressure is also equal to 0 cmH20 and the lung collapses. 

SuccessM treatment of PEA and asystole depends almost entirely on diagnosis of the underlying cause. Potentially reversible causes include (1) hypovolemia, (2) hypoxia, (3) preexisting acidosis, (4) hyperkalemia, (5) hypothermia, (6) hypoglycemia, (7) drug overdose, (8) cardiac tamponade, (9) tension pneumothorax, (10) coronary thrombosis, (11) pulmonary thrombosis, and (12) trauma. 

Respiratory alkalosis secondary to hyperventilation is usually observed secondary to CNS stimulation of ventilatory centers as a result of trauma, sepsis, or shock. Lung auscultation may reveal crackles (pulmonary edema) or absence of breath sounds (pneumothorax, hemothorax). Chest roentgenogram can confirm early suspicions or disclose an undetected abnormality such as pneumonia (pulmonary infiltrates). Continued insult to the lungs may result in adult respiratory distress syndrome. 

The history and physical examination should be obtained while initial therapy is being provided. A history of previous asthma exacerbations (e.g., hospitalizations, intubations) and complicating illnesses (e.g., cardiac disease, diabetes) should be obtained. The patient should be examined to assess hydration status use of accessory muscles of respiration and the presence of cyanosis, pneumonia, pneumothorax, pneumomediastinum, and upper airway obstruction. A complete blood count may be appropriate for patients with fever or purulent sputum. 

The most common cause of acute respiratory failure in COPD is acute exacerbation of bronchitis with an increase in sputum volume and viscosity. This serves to worsen obstruction and further impair alveolar ventilation, resulting in worsening hypoxemia and hypercapnia. Additional causes are pneumonia, pulmonary embolism, left ventricular failure, pneumothorax, and CNS depressants. 

Numerous case studies have described death following the accidental ingestion of kerosene by children (usually under the age of 5 but as old 15 years). The deaths are usually attributed to lipoidal pneumonia (Morrison and Sprague 1976 Santhanakrishnan and Chithra 1978 Zucker et al. 1986) that was probably induced by the aspiration of the kerosene. Specific respiratory effects associated with death from kerosene ingestion include pneumothorax (Mahdi 1988 Zucker et al. 1986), emphysema (Mahdi 1988), and pneumonitis (Singh et al. 1981). Cardiac arrhythmia was reported as the cause of death in one child however, it was suspected that myocarditis and pulmonary edema may have been the cause of the rapid deterioration and death of the child (Dudin et al. 1991). 

Respiratory Pneumonia pharyngitis sinusitis hyperventilation rhinitis apnea aspiration pneumonia asthma dyspnea atelectasis increased cough/sputum epistaxis hypoxia pneumothorax hemoptysis bronchitis chest pain pulmonary fibrosis. 

Aerosol - Several serious adverse events occurred in severely ill infants with life-threatening underlying diseases, many of whom required assisted ventilation. Additional reports of worsening of respiratory status, bronchospasm, pulmonary edema, hypoventilation, cyanosis, dyspnea, bacterial pneumonia, pneumothorax, apnea, atelectasis, and ventilator dependence have occurred. Sudden deterioration of respiratory function has been associated with initiation of aerosolized ribavirin use in infants. If ribavirin aerosol treatment produces sudden deterioration of respiratory function, stop treatment and reinstitute only with extreme caution, continuous monitoring, and consideration of coadministration of bronchodilators. 

Aerosol Adverse reactions may include anemia and hemolytic anemia apnea atelectasis bacterial pneumonia bigeminy bradycardia bronchospasm cardiac arrest conjunctivitis cyanosis digitalis toxicity dyspnea hypotension hypoventilation pneumothorax pulmonary edema rash reticulocytosis tachycardia ventilator dependence worsening of respiratory status. 

When the cardiac electrical activity is maintained, but there is no mechanical output (pulseless electrical activity, electromechanical dissociation), then hypovolaemia, tension pneumothorax, pulmonary embolism, cardiac tamponade, and various forms of metabolic or pharmacological disturbance may be responsible. In asystole or pulseless electrical activity (with an underlying rate of less than 60 beats per minute) a single intravenous bolus of 3 mg atropine is recommended. 

Respiratory effect. Barley ear inhaled by a 2.5-year-old child produced fever, dyspnea, right paracardiac infiltrate with pleural reaction on X-rays, and normal bronchoscopy after 8 days. On day 11, extensive right pneumothorax, and on day 20, right axillary inflammatory lesion were observed. On day 28, the ear of barley was expulsed and there was complete recovery . Barley spike, inhaled into the tracheobronchial tree of 18 children under the age of 5 years, produced coughing and choking in 14 of the children. The spikes were removed by laryngoscopy... 

Cardiac arrest, apnea and ventilator dependence, bacterial pneumonia, pneumonia, and pneumothorax occur rarely,... 

Nitrous oxide is approximately 34 times more soluble in blood than nitrogen. It will diffuse into, and from, air-containing cavities more rapidly than nitrogen. Thus, during nitrous oxide anaesthesia, air-or gas-filled cavities will tend to expand with the risk of rupture and pneumothorax, e.g. lung cyst, bullae. Similarly, chronic inflammation in the middle ear may result in blockage of the Eustachian tube. In these circumstances, nitrous oxide may induce barotrauma and pain. 

In cases of pneumothorax with closed thoracotomy tube drainage, chronic glucocorticoid treatment has been reported to delay and impede re-expansion of the lung (SED-8, 820). 

For the relief of pain arising from spasm of smooth muscle, as in renal or biliary colic, morphine is frequently employed. Other measures including antispasmodics such as atropine, atropine substitutes, theophylline, nitrites, and heat may be employed first however, if they are ineffective, meperidine, methadone, or opiates must be used. Morphine relieves pain only by a central action and may aggravate the condition producing the pain by exaggerating the smooth muscle spasm. Morphine may also be indispensable for the relief of pain due to acute vascular occlusion, whether this be peripheral, pulmonary, or coronary in origin. In painful acute pericarditis, pleurisy, and spontaneous pneumothorax, morphine is likewise indicated. Carefully chosen and properly spaced doses of codeine or morphine may occasionally be necessary in pneumonia to control pain, dyspnea, and restlessness. Traumatic pain arising from fractures, bums, etc., frequently requires morphine. In shock, whether due to trauma, poisons, or other causes, morphine may be required to relieve severe pain. 

Morphine depresses all phases of respiration (respiratory rate, tidal volume, and minute volume) when given in subhypnotic and subanalgesic doses (Figure 47.6). In humans, a morphine overdose causes respiratory arrest and death. Therefore, morphine and other narcotic analgesics should be used with extreme caution in patients with asthma, emphysema, and cor pulmonale, and in disorders that may involve hypoxia, such as chest wound, pneumothorax, or bulbar poliomyelitis. 

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