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spont. pneumothorax

Discussion in 'Step I' started by susan96, Apr 23, 2007.

  1. susan96

    susan96 Senior Member
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    is the trachea deviated to side of collapse? is it hyperresonant on the side of collapsed lung? (tension pneumothorax is opposite, right?)

    sorry, couldn't find info online
     
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  3. g.badran

    g.badran New Member
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    Pneumothorax is pneumothorax (spontaneous or tension), so there’ll be hyperresonance 2 percussion on the side of the pneumothorax (where the lung is collapsed)
    The trachea (&other medastinial structures) will be deviated opposite 2 the side of the pneumothorax (esp. if tension)
    that's what i know
     
  4. Krazykritter

    Krazykritter Senior Member
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    I'm going to most definitely disagree w/ g.badran...

    A Spontaneous pneumo will most often cause trachea deviation TOWARDS the side of the pneumo.

    A Tension pneumo will cause the trachea to deviate AWAY from the side of the pneumo.

    Hyperresonance on one side is to give you the side that the lung is collapsed on. For example a good question might be; Patient comes in after an MVA & you find hyperresonance over the left lung (this obviously tells you it's a pneumo), and trachea deviation to the right. What is the diagnosis. A: Tension pneumo b/c the trachea is deviated away from the side of the collapsed lung.
     
  5. basupran

    basupran ortho, study, cars, lift
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    TENSION PNEUMOTHORAX:
    Let's think about the pathophysiology here. Now, we know that the intrapleural space is negative relative to atmosphere. What does this mean? Air would love to get in there, but it can't, unless you pop a hole in the chest giving air access to this pleural space.

    To recap thus far: the intrapleural space (the region between the 'skin' that covers the lung and the skin that covers the inner chest) is negative. When you stab someone, air gushes into this space. What happens now? As air gets in this space, it creates pressure in that side (that side becomes the same as the atmosphre, while the other side is still negative, so relatively greater pressure), and then it gets bigger. Make sense? If not, make sure it does. Now, since the side with the stab wound is getting bigger, it is going to push against the mediastinum and other midline structures. Wait, the trachea is a midline structure. So this side that is getting bigger is pushing the trachea, hence the term contralateral tracheal deviation.


    Now, let's think of the concept of hyperresonance. Picture two drums (tablas if you will). One drum is empty, one drum is full of water. Which drum will 'resonate' louder? The empty one, of course. So, when you have a tension pneumothorax, you have an empty half of the thorax, so like a drum, it will resonate. This will obviously be ipsilateral, since the drum is on the same side.

    Hope this helps
     
  6. basupran

    basupran ortho, study, cars, lift
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    Oh yeah, don't forget...with the tension pneumothorax, the side with the stab wound-the cavity is filling up with air, which is making it an empty drum.
     
  7. basupran

    basupran ortho, study, cars, lift
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    This is correct.
     
  8. Krazykritter

    Krazykritter Senior Member
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    No offense intended, but you made that a lot more difficult than it really is...On the wards you are going to need to differentiate & thinking of a drum isn't going to help you much. It may, however, be good to know that a tension pneumo is associated w/ a one-way flap (as created by a stab wound).
     
  9. basupran

    basupran ortho, study, cars, lift
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    No offense taken, but taking a conceptual approach is a lot easier for me to understand vs what you may do-ie memorize tension contra, spontaneous ipsilateral. I can only get it when I take a full blown engineering approach...ie extrapolating from a little bit of info.
     
  10. buddindoc

    buddindoc Senior Member
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    HEY if u have goljan listen to his resp lec and he explains both pretty well and if u have seen THREE KINGS it helps (and i am not kidding)
     
  11. Krazykritter

    Krazykritter Senior Member
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    LOL...almost forgot about Three Kings. Needle Decompression FTW.
     
  12. PhatGtDmB

    PhatGtDmB Member
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    one more thing....people who are tall and thin are more likely to get spont. pneumothorax (i.e. rupture of subpleural bleb)...ship it....holla
     
  13. shivasHeroLike

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    good explanation basupran.

    i'm one of those that needs to understand the concept rather than memorize.

    the tabla analogy made sense to me. thanks.
     

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