An emergency room nurse is assessing a male client who has sustained a blunt injury to the chest wall. Which of these signs would indicate the presence of a pneumothorax in this client?
A. A low respiratory rate.
B. Diminished breath sounds.
C. The presence of a barrel chest.
D. A sucking sound at the site of injury.
Correct Answer: B. Diminished breath sounds.
This client has sustained a blunt or a closed chest injury. Basic symptoms of a closed pneumothorax are shortness of breath and chest pain. A larger pneumothorax may cause tachypnea, cyanosis, diminished breath sounds, and subcutaneous emphysema. Hyperresonance also may occur on the affected side. A pneumothorax is defined as a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and visceral pleura inside the chest. The air accumulation can apply pressure on the lung and make it collapse.
Option A: An increase in central venous pressure can result in distended neck veins, hypotension. Patients may have tachypnea, dyspnea, tachycardia, and hypoxia. Clinical presentation of a pneumothorax can range anywhere from asymptomatic to chest pain and shortness of breath.
Option C: Barrel chest could also be present which consists in increased anterior-posterior diameter of the chest wall and is a normal finding in children, but it is suggestive of hyperinflation with chronic obstructive pulmonary disease (COPD) in adults.
Option D: A sucking sound at the site of injury would be noted with an open chest injury. Open “sucking” chest wounds are treated initially with a three-sided occlusive dressing. Further treatment may require tube thoracostomy and/or chest wall defect repair.
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