d. Pain in shoulder and arm.
e. In tension pneumothorax, the percussion note is hyperresonant (louder) over
the involved side.
f. Diminished motion on the affected side.
A chest x-ray may be used to confirm the diagnosis of pneumothorax. A film
taken when the patient exhales will show air in the pleural space with a visible border of
retracted lung. The lung may have retracted in one area only.
a. Small Pneumothorax. No special treatment is required as the air is
reabsorbed in a few days.
b. Bilateral Pneumothorax. Introduce a chest tube with water-sealed drainage.
Suction the air out of the chest cavity so that the lung can expand rapidly.
c. Tension Pneumothorax. Insert a short, beveled needle or a chest tube into
the front part of the affected area of the chest and drain the air or fluid from the chest
Section III. PULMONARY EMBOLISM
Pulmonary embolism is defined as the sudden blocking of a pulmonary artery or
one of its branches by a blood clot or other obstruction. The obstruction is carried to the
site by the blood current. For example, blood clots may form in the veins of the legs or
pelvis and be carried through the veins, through the right heart, where they reach the
narrowing network of pulmonary vessels. Factors that favor the development of such
obstructions include the following.
a. Prolonged Immobilization. Blood becomes stagnant in the lower
extremities of bedridden patients, and blood clots can form. A lower extremity in a cast
is also conducive to blood clot formation.
b. Thrombophlebitis (Inflammation of the Veins). A patient suffering from
thrombophlebitis in the pelvis or legs may have blood clots form in either of those area.
c. Drugs. An individual taking certain drugs (for example, birth control pills) has
a higher risk of developing blood clots.