Comprehensive Respiratory System Disorders Q 4 - Gyan Darpan : Learning Portal
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Saturday, 23 April 2022

Comprehensive Respiratory System Disorders Q 4

Nurse Ruth assessing a patient for tracheal displacement should know that the trachea will deviate toward the:
     A. Contralateral side in a simple pneumothorax.
     B. Affected side in a hemothorax.
     C. Affected side in a tension pneumothorax.
     D. Contralateral side in hemothorax.

Correct Answer: D. Contralateral side in hemothorax.

The trachea will shift according to the pressure gradients within the thoracic cavity. If there is no significant air or fluid accumulation, the trachea will not shift. The pressure gradient inside the thorax changes with a pneumothorax. Normally the pressure of the pleural space is negative when compared to atmospheric pressure. When the chest wall expands outwards, the lung also expands outwards due to surface tension between parietal and visceral pleura.

Option A: Tracheal deviation toward the contralateral side in simple pneumothorax is seen when the thoracic contents shift in response to the release of normal thoracic pressure gradients on the injured side. When there is communication between the alveoli and the pleural space, air fills this space changing the gradient, lung collapse unit equilibrium is achieved, or the rupture is sealed. Pneumothorax enlarges, and the lung gets smaller due to this vital capacity, and oxygen partial pressure decreases.
Option B: In hemothorax, accumulation of air or fluid causes a shift away from the injured side. Traumatic pneumothorax can result from blunt or penetrating trauma, these often create a one-way valve in the pleural space (letting the airflow in but not to flow out) and hence hemodynamic compromise.
Option C: A tension pneumothorax can cause severe hypotension (obstructive shock) and even death. An increase in central venous pressure can result in distended neck veins, hypotension. Patients may have tachypnea, dyspnea, tachycardia, and hypoxia.

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