Pneumothorax and Barotrauma

First Things First (assess for & treat the following)

• Recognize pressure-related injury. Alveolar rupture causes gas to dissect along the bronchovascular bundle, causing:
  • Pneumothorax/tension pneumothorax
  • Bronchopleural fistula
  • Lung & subpleural air cysts
  • Pulmonary interstitial emphysema
  • Pneumomediastinum
  • Pneumoperitoneum/pneumoretroperitoneum
  • Subcutaneous emphysema
  • Systemic gas embolism
• Is urgent intervention needed?
  • Cardiac arrest (pulseless electrical activity)
  • Shock (BP < 80 mmHg; pulse >120)
  • Respiratory compromise (hypoxemia/hypercapnia)
    • Inability to ventilate; increased plateau (static pressure)
• Radiographic abnormality only?
  • Careful monitoring required
  • Pneumomediastinum & subcutaneous emphysema have risk of pneumothorax.
  • Pneumothorax in mechanically ventilated patient requires a chest tube.