PATHOPHYSIOLOGY
A. Anatomy & Physiology
The respiratory system includes the airways, lungs, bony thorax, and respiratory
muscles. These structures and the central nervous system work together to deliver
oxygen to the bloodstream and remove excess carbon dioxide from the body.
The thoracic contents are bounded by the chest wall, providing both the shape of
the thorax and protection for the intrathoracic contents. The skin, subcutaneous tissues,
and muscles that surround the rib cage and shoulder girdle appear radiographically
indistinguishable from each other, whereas on CT the skin, fat, and muscles are
recognized by their difference in attenuation. The hard endoskeleton of the thorax is
comprised primarily of the ribs, sternum, and spine anchored to the shoulder girdle by the
clavicles, scapulae, and surrounding muscles
The vertebral column and 12 pairs of ribs form the posterior portion of the thoracic
cage. The ribs, the major portion of the thoracic cage, extend from the thoracic vertebrae
toward the anterior thorax. Along with the vertebrae, they support and protect the thorax,
permitting the lungs to expand and contract. The vertebrae and ribs are numbered from
top to bottom. Posteriorly, certain landmarks are used to help identify specific vertebrae.
In 90% of people, the seventh cervical vertebra (C7) is the most prominent vertebra on a
flexed neck; for the remaining 10%, it’s the first thoracic vertebra (T1). Thus, to locate a
specific vertebra, count along the vertebrae from C7 or T1.
Reference:
Themes, U. (2016, June 01). Anatomy and physiology. Retrieved November 24, 2020, from
https://thoracickey.com/anatomy-and-physiology-2/
Themes, U. (2016, July 16). Basic Thoracic Anatomy and Physiology. Retrieved November 24, 2020, from
https://thoracickey.com/basic-thoracic-anatomy-and-physiology/
B. Overview of Disease
Stab wounds usually result from a thrusting mechanism with an object (e.g. knife
or scissors) that penetrates the skin and underlying tissue and may extend deeper to
breach anatomical cavities (e.g. peritoneal or pleural). The location of the injury, trajectory
of the object, size of the object and depth of injury all affect the potential damage that can
be inflicted. Depending on the location vascular injury (e.g. aortic, carotid) and injury to
highly vascular organs (e.g. spleen) may be acutely concerning. Injuries that may
compromise breathing mechanics (e.g. pneumothorax) and airway patency (e.g. trachea)
are also concerning. Visceral injury (e.g. intestinal perforation) is also significant.
Pneumothorax occur when parietal or visceral pleura is breached, and the pleural
space is exposed to positive atmospheric pressure. Normally, the pressure in the pleural
space is negative or sub atmospheric; this negative pressure is required to maintain lung
inflation. When either pleura is breached, air enters pleural space, and the lung or a
portion of it collapses. The kind of pneumothorax related to this case is traumatic
pneumothorax in which air escapes from a laceration in the lung itself and enters the
pleural space or from a wound in the chest wall. It may be a result of blunt trauma,
penetrating chest or abdominal trauma or diaphragmatic tears.
Hemopneumothorax is most frequently caused by a trauma or blunt or penetrating
injury to the chest. When the chest wall is injured, blood, air, or both can enter the thin
fluid-filled space surrounding the lungs, which is called the pleural space. As a result, the
functioning of the lungs is disrupted. The lungs aren’t able to expand to let in air. The
lungs then shrink down and collapse
Reference:
Hinkle, J. & Cheever K., Brunner & Suddarth’s Textbook of Medical-Surgical Nursing Vol. 1 24th edition.
Page 629
Cafasso, J. (2018, September 18). Hemopneumothorax: Treatment, Symptoms, and Causes. Retrieved
December 1, 2020, from https://www.healthline.com/health/hemopneumothorax
Smith, H. (n.d.). Stab wound (overview): Radiology Reference Article. Retrieved November 25, 2020, from
https://radiopaedia.org/articles/stab-wound-overview-1
C. Contextual mapping/ Schematic Diagram
Predisposing factors: Precipitating factors:
• Age ETIOLOGY: • Living environment
• Male of the patient
• Penetrating chest injury
• Relationship with
(stab wound)
other people
• Blunt trauma (rib fractures)
• Time of incident
• Damage from underlying
lung disease
Accumulation of air and Rupture of blood vessels, blebs Compression of the vena
blood in the pleural space. and bullae in thorax cava with impaired venous
return to the heart
Increased pleural space
volume Excessive blood loss
Intrathoracic pressure Decrease supply of blood
increased to the body
Reduced lung capacity Decreased oxygen supply
to the body
Respiratory distress Gas exchange problems
Ineffective breathing pattern dyspnea
Tension on mediastinal
structures Impede cardiac and
systemic circulation
PNEUMOTHORAX/
HEMOTHORAX
If treated: If not treated:
Complication prevention: Complications:
➢ Surgery ➢ Future collapsed
➢ Administration of of lungs
oxygen ➢ Shock
➢ Medication ➢ Hypoxemia
administration ➢ Respiratory failure
➢ Cardiac arrest
RECOVERY
DEATH
