Through the administration of high-flow oxygen, a nitrogen gas pressure gradient helps to reabsorb some of the intrapleural air. Emphasis should be focused on placing the patient on high-flow oxygen, as it relieves hypoxia and decreases the size of the pneumothorax. Once the diagnosis of pneumothorax is suspected, airway, breathing, and circulation should be secured according to standard EMS protocol. In the appropriate clinical setting of acute dyspnea, but equivocal breath sounds, EMS providers may percuss the thorax for unilateral hyper-resonance and asymmetric tactile fremitus in making the diagnosis. Low light, body fluid, and other environmental factors may make otherwise obvious chest wall openings unapparent in emergencies.

Definitive treatment of both conditions may require a chest tube depending on the level of severity, but only a tension pneumothorax will require needle decompression.Īmbient noise in the field may drown out differences in lateralized breath sounds. A key clinical finding that separates these two is that a pneumothorax will have hyper-resonance to percussion, but a hemothorax will have a hypo-resonance to percussion.

A hemothorax will have a similar presentation as a pneumothorax, with symptoms such as dyspnea, hypoxia, decreased breath sounds, and chest pain. Many patients will have comorbid conditions that may mimic a pneumothorax including COPD/asthma, congestive heart failure (CHF), and pleural effusions, which may cause decreased breath sounds during acute exacerbations and acute dyspnea. They do not have access to emergency department diagnostic equipment such as chest radiographs and point of care thoracic ultrasound which may clinch the diagnosis. EMS providers may be called to the outpatient setting where medical procedures involving the chest or neck may cause an iatrogenic pneumothorax, such as central venous catheter placement, thoracentesis, and lung biopsies.ĮMS providers are challenged in making the diagnosis for several reasons. EMS providers may also encounter several different mechanisms of injury that violate the pleura creating a pneumothorax, such as penetrating trauma to the chest or blunt trauma with a rib fracture. It can also occur secondarily as a part of a chronic lung disease such as chronic obstructive pulmonary disease (COPD), interstitial lung disease, or pneumocystis pneumonia (PCP) due to the destruction of lung tissue. Lung tissue can spontaneously rupture in patients with risk factors such as tobacco use, Marfan’s syndrome, underwater diving, airplane travel, and male gender. Air can enter the chest cavity from a disrpution in the lung tissue or trauma to the pleura. Pneumothorax is the entry of air into the potential space between the parietal and visceral pleura. The condition spans all age groups, and EMS providers should, therefore, maintain a high index of suspicion for pneumothorax for any patient with a sudden onset of acute respiratory distress and ipsilateral chest pain. It is commonly associated with complaints such as chest pain, shortness of breath, and trauma. Lung sounds.Pneumothorax is a principal diagnosis for emergency medical services (EMS) providers to identify, which is a potentially life-threatening condition. Fine crackles on chest auscultation in the early diagnosis of idiopathic pulmonary fibrosis: A prospective cohort study. Monophonic and polyphonic wheezing classification based on constrained low-rank non-negative matrix factorization. You can learn more about how we ensure our content is accurate and current by reading our editorial policy. We link primary sources - including studies, scientific references, and statistics - within each article and also list them in the resources section at the bottom of our articles. Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations.

Pneumothorax lung sounds