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Iatrogenic Pneumothorax


Presentation

  • All patients were symptomatic and presented within 24 hours of EMG. Sampling of serratus anterior and diaphragm was causative in 1 patient each. In 5 patients, multiple high-risk muscles were sampled.[ncbi.nlm.nih.gov]
  • Further prospective studies are required to clarify the results of the present study.[jtd.amegroups.com]
  • We present the case of an iatrogenic pneumothorax during placement of the chest sensor lead between the intercostal muscles. Following clinical and radiological evaluation, surgery was continued and the patient was treated expectantly.[ncbi.nlm.nih.gov]
  • Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. Ann Intern Med. ‎[books.google.de]
  • False positive cases were mostly a result of exclusionary conditions (11%) and pneumothoraxes that were present on admission (7%). About 44% of events followed attempted central venous catheter (CVC) placement.[ncbi.nlm.nih.gov]
Dyspnea
  • Large volume pneumothoraces cause dyspnea, tachycardia, hypotension, and hypoxia. Clinical signs of tension pneumothorax include tracheal deviation, hyperresonance, and hypotension.[aneskey.com]
  • […] tomography-guided radiofrequency tumor ablation acupuncture Stay alert for problems 6,7 Signs and symptoms of iatrogenic pneumothorax include: ipsilateral chest pain that may radiate to neck, back, and shoulder hemodynamic instability tachycardia tachypnea dyspnea[journals.lww.com]
  • Patients with pneumothorax present with sudden-onset dyspnea, ipsilateral chest pain, diminished breath sounds, and hyperresonant percussion on the affected side.[amboss.com]
  • Dyspnea and chest pain are the most common symptoms of pneumothorax. Decreased breath sounds and lack of movement on the affected side may also be observed.[teleflex.com]
  • Suspicion for pneumothorax should remain heightened in patients with chronic obstructive pulmonary disease (COPD) who develop dyspnea and unilateral chest pain.[razianesth.freeservers.com]
Hyperresonance
  • Clinical signs of tension pneumothorax include tracheal deviation, hyperresonance, and hypotension. DIAGNOSIS AND DIFFERENTIAL Electrocardiographic changes, including ST changes and T-wave inversion, may be seen with pneumothorax.[aneskey.com]
  • 6,7 Signs and symptoms of iatrogenic pneumothorax include: ipsilateral chest pain that may radiate to neck, back, and shoulder hemodynamic instability tachycardia tachypnea dyspnea hypoxemia ipsilateral decreased or absent breath sounds ipsilateral hyperresonance[journals.lww.com]
  • Patients with pneumothorax present with sudden-onset dyspnea, ipsilateral chest pain, diminished breath sounds, and hyperresonant percussion on the affected side.[amboss.com]
  • Physical exam findings for a pneumothorax are unequal breath sounds, hyperresonance with percussion over the chest wall, and decreased wall movement on the affected side of the chest.[cdemcurriculum.com]
  • In a large pneumothorax, physical signs include absent breath sounds, tachypnoea, decreased chest wall movement, hyperresonance to percussion, decreased vocal resonance and tracheal deviation to the opposite side.[quartz.tg.com.au]
Pleuritic Pain
  • Most patients complain of acute onset pleuritic pain and have diminished breath sounds on the affected side. Large volume pneumothoraces cause dyspnea, tachycardia, hypotension, and hypoxia.[aneskey.com]
  • Chest pain : a pleuritic pain may give a sensation of breathlessness. Examples include pleurodynia and Bornholm disease. Pulmonary embolism may produce haemoptysis and a few rales over the affected area.[patient.info]
Chest Pain
  • A pneumothorax is a type of lung injury that allows air to leak into the area between the lungs and the chest wall, which causes mild to severe chest pain and shortness of breath.[quality.nm.org]
  • He states he started having left-sided chest pain and trouble breathing about 15 minutes earlier but thought it would get better on its own. You suspect that Mr. S may have an iatrogenic pneumothorax and immediately activate the rapid response team.[journals.lww.com]
  • Onset of pneumothorax is marked by sudden sharp chest pain, shortness of breath and an unproductive cough.[healthcmi.com]
  • Dyspnea and chest pain are the most common symptoms of pneumothorax. Decreased breath sounds and lack of movement on the affected side may also be observed.[teleflex.com]
  • The most common symptoms include: Sharp, stabbing type chest pain that may spread to the shoulder and back Shortness of breath or trouble breathing Fast, shallow, breathing In more severe cases, symptoms can also include: Fast heartbeat Bluish tinge to[fairview.org]

Treatment

  • […] report show the subtle radiographic findings on the plain film, less subtle findings on computed tomographic scan, and what we believe is the first to be reported 3-dimensional reconstructed image of an acupuncture needle remaining in the chest after treatment[ncbi.nlm.nih.gov]
  • Most patients required treatment for 4-7 days; however, hospitalization was prolonged due to this treatment in only 8% of patients, presumably because of their underlying disease which required long hospitalization.[ncbi.nlm.nih.gov]
  • Iatrogenic means that is was caused by medical treatment, often as an incidental event during a procedure.. Most cases of iatrogenic pneumothorax are not serious and do not require any treatment.[quality.nm.org]
  • CONCLUSION: Conventional chest tube therapy is a safe and effective treatment for iatrogenic pneumothorax. In patients with an underlying lung disease, gas egress may last for up to 10 days.[ncbi.nlm.nih.gov]
  • Hypoglossal nerve stimulation is a promising new treatment for patients with obstructive sleep apnea.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis Up to 50% of patients who suffer from a pneumothorax will have another or a recurring pneumothorax. However, there are no long-term complications after successful treatment.[physio-pedia.com]
  • Prognosis [ 1 ] While death from spontaneous pneumothorax is rare, rates of recurrence are high: 15.8% at one year for PSP and 31.2% at one year for SSP.[patient.info]
  • Instillation of a sclerosant through a chest tube may be used in certain circumstances (Good Consensus) based on patients’ contraindications to surgery, management preferences, and underlying poor patient prognosis (see below for sclerosant choice).[enotes.tripod.com]
  • Most studies of the prognosis and outcome of IP were retrospective and focused on a single category of IP. 9,11–17 The development of lung-protective strategies for ventilation and of new material, techniques, and recommendations for inserting central[anesthesiology.pubs.asahq.org]

Etiology

  • Further randomized control studies are warranted to evaluate the etiology of this finding. Published by Elsevier Inc.[ncbi.nlm.nih.gov]
  • Abstract The purpose of this study was to delineate the etiological factors for iatrogenic pneumothorax in the era of increased use of invasive procedures and to determine its impact on morbidity.[ncbi.nlm.nih.gov]
  • BACKGROUND: We discuss the etiology and incidence of iatrogenic pneumothorax (IPnx) which can develop after invasive procedures performed for diagnostic and/or therapeutic purposes, and the efforts to prevent this complication and its consequences.[ncbi.nlm.nih.gov]
  • We report this case for its rarity, due to the critical importance of this cause as a etiology of bilateral simultaneous iatrogenic pneumothorax leading to cardiac arrest situation, and need to understand the importance of continuous training and stress[ijccm.org]
  • : pneumothorax occurs as a complication of underlying lung disease Tension pneumothorax : life-threatening variant of pneumothorax characterized by progressively increasing pressures within the chest and cardiorespiratory compromise References: [1] Etiology[amboss.com]

Epidemiology

  • Epidemiology Primary spontaneous pneumothorax Sex : ( approx. 6:1 ) Peak incidence : 20–3 0 years Secondary spontaneous pneumothorax Sex : ( approx. 3:1 ) Peak incidence : 60–65 years References: [1] Epidemiological data refers to the US, unless otherwise[amboss.com]
  • EPIDEMIOLOGY Patients who received mechanical ventilation have an approximate incidence of barotrauma of 4%-15%[ 4, 13, 19, 25 ].[ncbi.nlm.nih.gov]
  • Epidemiology The incidence of primary spontaneous pneumothorax (PSP) is 24/100,000 a year in men and 9.9/100,000 a year in women in England and Wales [ 4 ].[patient.info]
  • . † Professor, Group of Epidemiology, Institut National de la Santé et de la Recherche Médicale (INSERM) U578, Grenoble, France, and Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Teaching Hospital, Paris, France[anesthesiology.pubs.asahq.org]
  • In Stockholm, in one of the largest epidemiologic studies performed (reported by Bense et al), the annual incidence of PSP in 15,204 individuals was somewhat higher than in the Minnesota study: 18 per 100,000 men and 6 per 100,000 women.[razianesth.freeservers.com]
Sex distribution
Age distribution

Pathophysiology

  • In the following review, we discuss pathophysiology, diagnosis, and expected outcomes. Surgeons placing hypoglossal nerve stimulators should be aware of complications and prepared to manage a pneumothorax.[ncbi.nlm.nih.gov]
  • PATHOPHYSIOLOGY Pneumothorax likely occurs after rupture of a sub-pleural bulla allows air to enter the potential space between the parietal and visceral pleura, leading to partial lung collapse.[aneskey.com]
  • PATHOPHYSIOLOGY AND RISK FACTORS FOR PRMV An early investigation reported that peak airway pressure over 50 cm H 2 O is associated with increased risk of alveolar rupture during mechanical ventilation[ 4 ].[ncbi.nlm.nih.gov]
  • Gioffrè Florio The aim of this study was to collect information on the incidence, pathophysiology, treatment and mortality of pneumothorax in the Emergency Room.[giornalechirurgia.it]
  • References: [1] Pathophysiology Increased intrapleural pressure alveolar collapse decreased V/Q ratio and increased right-to-left shunting Spontaneous pneumothora x : rupture of blebs and bullae air moves into pleural space with increasing positive pressure[amboss.com]

Prevention

  • In the new issue of SonoSite news, it discusses this and how the tool that could prevent pneumothorax from occurring, if used during your procedures, is the exact tool that is best to diagnose at bedside. How ironic is that?![sonospot.wordpress.com]
  • […] catheterization procedure, the clinician accidentally causes a pneumothorax, Medicare will no longer reimburse the hospital for the extra costs of a resulting pneumothorax (collapsed lung) complication.Medicare’s inclusion of iatrogenic pneumothorax as a preventable[sonosite.com]
  • In this case, we effectively utilized ultrasound and avoided preventive chest tube placement and the associated complications.[dovepress.com]
  • At least 1725 hospital-acquired pneumothoraxes could have been prevented in 2004 through universal use of ultrasound guidance during internal jugular cannulation.[ncbi.nlm.nih.gov]
  • Between 1983 and 1987 the Department of Veterans Affairs conducted a cooperative study at 13 medical centers to assess the utility of the intrapleural instillation of tetracycline for the prevention of recurrent pneumothorax.[ncbi.nlm.nih.gov]

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