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Pneumothorax vs. hypovolemia.

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by jhwang2 jhwang2 (New Member) New Member

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I am an LPN going back to school to get my RN degree.

The question came up in the class as to why pneumothorax initial has same s/s as hypovolemia which often leads to misdiagnosis and slow. Nobody including my nursing instructors, could answer that one.

Any idea?

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Double-Helix has 6 years experience as a BSN, RN and specializes in PICU, Sedation/Radiology, PACU.

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Well, I can't say that I agree that a pneumothorax and hypovolemia have the same symptoms.

Pneumothorax is a collapsed lung. Major symptoms are respiratory distress, tracheal deviation, unequal breath sounds and unequal chest rise. Usually chest pain and tachycardia are also present.

Hypovolemia is insufficient amounts of intravascular fluid. Symptoms can be tachycardia, tachypnea, low blood pressure, poor perfusion, slow cap refill, and signs of dehydration.

If you're doing a thorough assessment- including heart and lung sounds, there should be no mistaking a pneumothorax for hypovolemia. Exceptions might be a trauma situation, where both major blood loss and pneumothorax could occur simultaneously. But in that example, both problems are occurring. One is not being mistaken for the other. The initial treatment is the same: Support the patient with fluids and oxygen until you get to the hospital, where they will undoubtably be assessed and have an X-ray done which will show the pneumothorax.

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Esme12 is a ASN, BSN, RN and specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

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I agree with Ashley. In trauma there may be initial delay of diagnosis of a subtle pneumothorax in the presence of distracting injuries (more serious) if the patient is not c/o SOB. Each may have a subtle initial presentation of restlessness, tachycardia, and pallor with a sense of impending doom/anxiety but with further mechanism of injury clarified and assessment usually clarifies the situation before a catastrophic event occurs.....so I am not sure what your instructors were saying about this subject.

If you give me a little more detail I am sure I can tell you how and why.

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ckh23 has 6 years experience as a BSN, RN and specializes in ER/ICU/STICU.

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I wouldn't say the symptoms are the same, but they can be similar. They both can present with tachycardia and hypotension, but they also both have different symptoms that help differentiate each other. This is where your physical assessment comes into play.

On a side note I think it today's world of medicine there is an extreme downplay of physical assessments because of all of the fancy gadgets and tests. However, they are never a substitute for a good thorogh physical assessment. I once saw an attending come down on a resident because of the lack of assessment. The resident had ordered the right tests and came up with the correct diagnosis and treatment, but when asked about his findings during an assessment he had no answers.

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when i read the thread title i thought, "oh, ok, i'll take door numbah two, hypovelemia, alex!" that's easier to fix.

 

but i can't imagine anyone saying it's possible to confuse the two if you've done the most cursory physical exam.

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Inori has 3 years experience as a BSN, RN and specializes in Ambulatory care.

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Without lseeing your example symptoms the only thing i can think of as signs/symptoms would be the same is if both pt are going into shock,hypoxia iotherwise no way it's similar towards end yep all things lead to shock if don't catch it early enough. . Pneumo ..well punctured lung he's bleeding somewhere, increased intra something pressure lungs can't expand cNt get enough Ir lead to hypoxia. Hypovolemia can lead to hypoxia and carcinogenic shock. Look up shock for symptoms. Usually increased Resp, decr BP, inc HR, cool clammy skin, loc confusion, restless, prob more. A definitive dx for pneumothorax is X-ray which will show the lung w prob. Yes to other posters about physical assess.

Edited by Inori

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guest042302019 is a BSN, RN and specializes in Progressive, Intermediate Care, and Stepdown.

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I guess they could be similar in VS related to the compensatory mechanisms of the body response to the condition. For instance, tachypnea and tachycardia. I can't imagine one having hypotension during a pneumothorax unless there is significant bleed. There could also be a drop in pulse ox in both cases. During pneumothorax, loss of negative pressure in pleural cavity and alveoli having the inability to properly inflate leading to less O2 diffusion across the membrane. And, during hypovolemia, there could be less RBCs for O2 to attach to therefore a decrease in Pulse Ox. I bet there are also similar neuro changes such as anxiety, decreased loc, or confusion. However, once one does a physical assessment and surely asking about pain, the two are likely very different. Never come across a pneumothorax though. Good luck in school!!! :D

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cnmbfa has 40 years experience and specializes in OB/women's Health, Pharm.

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Severe enough pneumothorax can interfere with return of blood to the heart form the lungs, and will definitely impair oxgenation. Heart rate and RR go up in response; BP goes down as attempt to maintain caridiac output is unsuccessful. Then we see poor perfusion, decreased urine output, etc. Maybe no one thought to listen to the lungs in a post op pateint, or did what I often see: superficial lung sounds done only over the bronchus, which will not catch a aprtial pneumothorax.

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tcvnurse has 15 years experience as a BSN, RN and specializes in Thoracic Cardiovasc ICU Med-Surg.

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*Shrug* On our unit there is no mistaking one for the other. The guy with the dropped lung often has trouble breathing, and chest/lung pain. The hypovolemia folks have low bps, tachy, othostatic, dizzy etc. Maybe I just see a lot more pneumos than most, but I don't think I would mistake the two.

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I can tell the symptoms and signs of spontaneous pneumothorax from my own experience.

I had a spontaneous pneumothorax on the left side when I was 23 (I'm male).

There was no initial "severe pain" or any pain at all I would be aware of, except from pain with every deep breath, also no breathing problems aka grasping for air, no dizziness, sweating or any other noticeable symptom. I felt slightly increasing vague discomfort in my upper chest and shoulders. Any movement of my arms or rotating my upper body would greatly increase discomfort. I also felt a slight pain behind the sternum, which I attributed to a "nervous heart." As a medical student I could not get rid of the thought about angina pectoris or "something being wrong with my heart" because I was diagnosed with an "innocent heart murmur" few years before the event. I went to sleep, but could not get any comfortable position, because of upper body pains.

The next morning I went (by foot) to a doctor, who made a correct diagnosis in 2 minutes. After telling her my symptoms, she auscultated my lungs on the back — no breathing sounds on the left.

Initial symptoms of hypovolemia or hypovolemic shock are thirst, increased heart rate, dizziness, pale, sweaty and cool skin.

Hypovolemic Shock Pathophysiology, Symptoms, Signs, Treatment | eHealthStar A person with pneumothorax (without bleeding) does not likely have these symptoms, except increased heart rate.

In traumatic pneumothorax as a part of severe injury as a car crash, hypovolemia could occur due to bleeding caused by broken ribs, other bones or ruptured spleen...

In summary, by my opinion, absent breathing sounds on one side of the chest is the only reliable sign of spontaneous or simple traumatic pneumothorax; all other symptoms and signs are nonspecific. In hypovolemic shock alone, breathing frequency can be increased, but breathing sounds should be equal on both sides (in healthy lungs).

Edited by healthresearch

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