Spontaneous Pneumothorax

Spontaneous Pneumothorax 1

Spontaneous Pneumothorax

Lacey Shelton

Professional Role Development

Middle TN State University

Spontaneous Pneumothorax 2

Kevin is a healthy nonsmoking 18 year old male who was 6'2" and weighed about 145 pounds. On May 16th, 2001 he was sitting in his high school chemistry class when he started getting hot and sweaty. He got up and went to the water fountain when he started noticing right arm pain. When he returned to the class room the teacher told him he looked green. The pain he was having in his right arm was spreading to his whole right upper side of his body. He said it felt like a bad muscle cramp. His teacher made him go to the school office where they called EMS and brought him to the hospital. On the ride to the hospital an IV was started along with 2L of O2 per NC. Kevin also said he was starting to get short of breath. Once in the ER Kevin had a chest x-ray that showed a 25% pneumothorax of his right upper and middle lobes. A Chest tube was placed and Kevin was admitted. Kevin stayed in the hospital for 5 days, with his chest tube in place for 4 of those days. He had a chest x-ray done every morning. Kevin was also on 2L O2 per NC as needed. An incentive spirometer was given to him on his last day in the hospital. Kevin has never had his pneumothorax reoccur.

What Kevin had was a spontaneous pneumothorax. A spontaneous pneumothorax (SP) usually occurs for no know reason, most commonly in young tall skinny males that smoke. There are three types of spontaneous pneumothorax, primary, secondary, and catamenial. Kevin had a primary SP. The signs and symptoms of a SP are pretty recognizable but can be the same as other types of pneumothorax. SP's are not usually life threatening if treated quickly and the treatment is usually routine.

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According to Porth, a SP occurs when an air filled bleb on the lung ruptures. This allows atmospheric air from the airways to enter the plural cavity. Because the alveolar pressure is greater then the plural pressure the air flows from the alveoli into the plural space. This causes that portion of the lung to collapse causing a pneumothorax (Porth, 2004, pg. 691). A bleb is a fluid or air filled "blister" on the lung. An over-stretching of lung tissues due to a long thorax and growth spurts in early to late teens can cause the bleb to occur and rupture (TSPPN, 2004). Basically because the person is tall and skinny their lung length is increased. The blebs form due to the pleura (outer lining of the lung) rubbing on the chest wall. After the bleb is formed the continuous rubbing causes the bleb to rupture causing a small hole in the lung that lets air out into the lung lining.

A primary SP usually occurs in healthy young tall skinny men between the ages of 10 and 30. These men usually have blebs on the top of their lungs because of a difference in plural pressure between the top and bottom of their lungs (Porth, 2004, 692). People who dive or participate in high altitude flying can also have primary SP because of the changes in altitude (Merck, 2005).

A secondary SP occurs in people with extensive lung damage. Many types of lung diseases such as COPD, emphysema, cystic fibrosis, sarcoidosis, TB, and pneumonia can cause a secondary SP (Merck, 2005). A secondary SP is much more life threatening because the person already has decreased lung function and the SP only decreases it more.

A catamenial SP is a very rare condition that occurs during a females' menses (Marx, 2002, pg. 1001). This type of SP is recurrent and usually occurs within 72 hours

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of each monthly menses (Marx, 2002, pg. 1001). The exact cause of this is unknown but ovulation-suppression medication usually helps stop the SP from occurring.

Symptoms of a SP depend on how much air has entered the plural space, how much of the lung has collapsed, and the person's lung function before the pneumothorax (Merck, 2005). Most people complain of shortness of breath, sharp chest pain, a sudden dry hacking cough, and pain in the shoulder, neck, and arm of the affected side (Marx, 2002, pg. 1001). If the SP is not large or severe the symptoms gradually decrease as the body becomes used to the change and the SP will resolve it's self. On physical examination auscultation and percussion of the chest can help determine the degree of the SP. Auscultation would allow the doctor to listen for the area of the chest that