the integrity of the pleural cavity is breached from without as the result of trauma, such as a gunshot wound, stab wound, or crushing type of wound to the chest. The object (possibly the patient's own rib) penetrates the chest cavity, allowing air to enter from the atmosphere. Gas or an accumulation of pus in the pleural space generated by microorganisms can result in a pneumothorax. Diagnosis Diagnosis is made after evaluating the history, the clinical findings, and radiographic studies. Radiographic films will show the air in the pleural cavity, the collapsed portion of the lung, and mediastinal shift. Breath sounds are diminished, and sucking air sounds are heard at the wound site. The patient is in acute distress.
Unit 5: Diseases of the Human Body Treatment The patient is more comfortable in a Fowler's or a semi-Fowler's position and may require oxygen. An occlusive dressing is placed over any sucking wound to seal the portal of entry and to prevent additional air from entering the chest cavity. A thoracostomy is performed to withdraw air from the cavity. A closed drainage system is established if air continues to leak into the pleural space. This allows expansion and healing of the lung. Prognosis Recovery depends on the degree of lung collapse, the cause, and prompt medical intervention. Prevention No specific measures of prevention are known. Patient Teaching Throughout emergency care and after the patient is medically stable, offer support to the individual and family. Patients receiving conservative therapy are encouraged to rest during a period of close monitoring. More severe cases or those that result from trauma will require teaching about treatments used to expand the lungs. Use visuals such as customized electronically generated patient education on the anatomy and physiology of the lungs. Hemothorax Description Hemothorax is the accumulation of blood and fluid in the pleural cavity (see Figure 9-17 ). ▪ ICD-9-CM Code 511.8 ▪ ICD-10-CM Code J94.2 (Hemothorax) o P54.8 (Other specified neonatal hemorrhages) o S27.1 (Traumatic Hemothorax) o A15.6 (Tuberculous pleurisy) Symptoms and Signs The patient experiences symptoms similar to those of a pneumothorax. Signs of hemorrhage include pale and clammy skin, a weak and thready pulse, and falling blood pressure. The patient may experience chest pain, and respirations are labored and shallow or gasping.
Unit 5: Diseases of the Human Body Patient Screening A hemothorax is life threatening and requires emergency medical care. Etiology Blood enters the pleural space as the result of trauma, erosion of a pulmonary vessel, or hematologic disorders. This causes the lung to collapse. Diagnosis Breath sounds are diminished or absent on the affected side, as is chest wall movement. Radiographic films show blood in the pleural space. Blood tests indicate hemorrhage; arterial blood gas analysis reflects respiratory failure. The patient is in acute distress. Treatment The treatment employed is similar to that for a pneumothorax. The lung must be reexpanded,
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