Hi, welcome to this video on nursing school explained about attention pneumothorax, which can be a life-threatening emergency. If we look at the anatomy here and what happens, then we can kind of deduce the signs and symptoms and treatment options that we'll have. So I've drawn out here a torso and down here is the belly with the belly button. And over here we have the normal anatomy with the trachea at the midline, the heart in red and both lungs on each side in blue. So this is normal anatomy. Now in attention pneumothorax, as the name already implies, there is some tension in the chest and the lung is collapsed for whatever reason. So now if there was penetrating trauma, so now air enters the pleural space for whatever reason and we'll look at those here in a moment. The contents of the chest cavity start to move over to the unaffected side because now there's air in a space that it doesn't belong and every time the patient inhales it pushes the contents of the chest over to the other side, to the unaffected side. And this is also called a medial spinal shift because all the contents in your chest cavity are referred to as the medial stynum. So this medial stynum shift happens due to this increase in intrathoracic pressure. Causes are an open or a closed pneumothorax. So any kind of pneumothorax the patient experiences, whatever the reason is can cause this because now we have air outside the lung inside the pleural cavity, whether there's an opening to the chest wall or not, there's some sort of tension building up and the contents of the chest of the medial stynum move over to the unaffected side. Mechanical ventilation can also cause attention pneumothorax and what happens here, if the ventilator malfunctions or maybe there's too much peep, positive end expiratory pressure, that fills up those alveola, it can burst the alveola, they can burst open these blips, they can rupture. Now the air escapes from the lung itself into the blural space because now that bleb has opened and then it gets contained in the pleural cavity, but again it enters that cavity and it pushes the lung over because the air is not supposed to be in the pleural cavity, it's supposed to be contained inside the lung. And then chest tube complication, so a patient that they already have a chest tube for whatever the indication is, if there are complications such as a kink in the chest tube or a mucus plug or any kind of malfunctioning equipment, the suction is off, the suction canister gets knocked over, all kinds of things can happen to where all of a sudden now the chest tube that's also the treatment for tension pneumothorax is not working, it can cause attention pneumothorax. So as you can imagine, signs and symptoms here are pretty significant because if all the contents in your chest cavity move over one way, you're going to have symptoms and you're not going to have these symptoms very long before you suffer dire consequences. So most common signs and symptoms dismay us, certain degree of shortness of breath, most definitely because we definitely cannot have gas exchange here plus the heart, the filling ability and the pumping ability of the heart are impaired. The patient will be cyanotic, there's no oxygen exchange, no oxygen being profused to the tissues, therefore patient will be extremely agitated, they will have this kind of air hunger symptoms. There will be absent breath sounds. If we don't have a lung on this side, we are not going to be able to hear breath sounds on this one side. The trachea will be deviated, so as the contents of the chest cavity move over, the trachea will move too because that's a structure that's attached to the both lungs. And as the lungs move over, also the trachea will move. And then there will be subcutaneous emphysema that you can palpate, which is the palpation of this air that's now in the pleuro cavity, basically between the lung and the skin and you can actually feel that, it almost feels like bubble wrap underneath the skin. And then the patient might also have JVD's jugular venous distention because now the heart is not able to feel and that blood is going to back up into the jugular venous system. Complications, not too many, but unfortunately death is the only thing that can happen here if we don't interact or act quickly here to resolve this tension pneumothorax. As a diagnostic test, sometimes a chest x-ray is required, sometimes the signs and symptoms are so significant that you don't even have time to snap a chest x-ray to be before actually treating this. And then certainly we need to be able to troubleshoot the equipment. So this happens in the ICU when the patient is on mechanical ventilation and there's some sort of a malfunctioning of the equipment, whether it's from the tube itself or the ventilator or whatever the equipment is, the chest tube itself. So we need to be able to troubleshoot the equipment. Of course, these are nurses that are highly trained in these areas that have experience with this equipment and also know how to troubleshoot it. So it's very important that you know how to work the equipment that the patient is hooked up to so that you know how to solve any problems that might arise. Treatment for this. So again, we have troubleshooting the equipment here. So if this is just a mucus plug, let's say, or a kink chest tube, we un-kink it, everything is going to fill back up, the chest contents are going to move back over where they're supposed to be and problem solved. But if it's not, we might need to perform a needle decompression, which is basically just like it sounds, a needle inserted in the upper chest cavity here between the ribs and this needle just lets the air escape out of the patient's pleural cavity so that then the contents of the medecinem can expand and go where they're supposed to. And then a more definitive treatment is a chest tube placement if this is a new tension pneumothorax and that's probably most likely going to be because of some traumatic injury. Nursing care. Again, this is a very sick patient. So in terms of our A, Bs and Cs, air we want to make sure we provide supplemental oxygen to the patient, elevate the head of the bed unless it's contraindicated for whatever reason if this is a trauma victim, for example, and we still need to protect their C spine. And then we need to have the intubation equipment ready because this can go south pretty quickly. And then for B, for breathing, everything except everything that we had here from A on the airway, but we're also of course going to monitor the patient's O2sad to see how they're perfusing and oxygenating. For C circulation, we want to make sure we have two IVs, large bore IVs in this patient because they might need fluid administer, they might need blood products if it's a hemothorax, or we might need to administer vasopressors if the patient's blood pressure gets really low and we can resolve it quickly. And of course we want to do frequent vital signs and place the patient on the heart monitor. And so nursing care, again, always troubleshoot the equipment and assist with any procedures such as the needle decompression and chest to placement. So in summary, knowing the equipment that you're working with is super important, knowing how to troubleshoot it, knowing who to ask if you don't know when a certain thing or if you see just signs and symptoms that are starting to develop here, make sure you interact very quickly so the patient's life can be saved. Thanks so much for watching this video on tension pneumothorax. Also check out my other videos in the emergency disaster trauma management playlist as well as the critical playlists to get more familiar with these kind of topics. I also have lots of videos on mechanical ventilation, intubation and all the equipment. Thanks for watching Nursing School Explained, see you soon.