1. Pneumothorax Hemothorax Orientation 2003

2. Signs & Symptoms 4 Increased oxygen support 4 Poor gases 4 Dyspnea - labored breathing 4 Diminished or no breath sounds 4 Crepitus in upper or lower lung fields 4 Apnea, bradycardia 4 Low or falling saturation

3. TREATMENT 4 May resolve without treatment if asymptomatic 4 100 % Oxygen by head hood (Nitrogen washout) 4 Thoracentisis (needle aspiration) 4 Placement of thoracotomy or chest tube

4. Head Hood - 100 % Oxygen Used with asymptomatic or non ventilated infants. Helps in the absorption of the air by the pleural capillaries. This treatment is not recommended in preterm infant due to oxtocity.

5. Thoracotomy Placement of tube in the chest cavity to a drainage system Water seal system (Pleur-vac, Atrium, water bottle set up, or Thoraseal) Non-water seal system (Thoraklex) Continuous negative pressure of 10 - 20 cm H20

6. THORACENTISIS Removal of air by needle aspiration Performed at the bedside by MD May be before a thoracotomy tube is placed May be done more than once

7. Assisting w/thoracentisis 4 Obtain the correct equipment (see handout) 4 MD may ask you to pull off air while they stabilize the needle placement –gently turn stopcock off to atmosphere and open to infant and syringe –gently pull fluid/air into syringe –turn stopcock off to infant and open to atmosphere and syringe –expel air/fluid with caution and appropriately –document amount of fluid/air removed, status of infant

8. DOCUMENTATION 4 events leading to detection of air leak 4 how the air leak was detected 4 who performed the needle aspiration & what was aspirated 4 amount color and consistency of aspiration 4 chest tube placement, size, type 4 type of drainage system and suction pressure 4 presence of bubbling as well as pattern in drainage system

9. 4 indicate if air leak is present 4 use of sedation/anesthetics 4 patient’s tolerance and comfort 4 appearance of CT site and dressing 4 Breath sounds and respiratory effort 4 Any resuscitation efforts