In many serials about doctors and detectives, we often come across words, the meaning of which we understand poorly or do not understand at all. For example, pneumothorax. What is this disease? Symptoms, signs by which the ambulance staff so accurately determine its presence, the amount of assistance and many other aspects of this issue remain behind the scenes. In this article you will find answers to help you navigate a critical situation.
Definition
Pneumothorax is an accumulation of air or other gas in the chest cavity. Most often occurs after injuries as a result of an open fracture of the ribs or injury to the lung with a bone fragment, as well as as a result of rupture of a lung abscess, opening of a bulla, or melting of the bronchial wall by a malignant neoplasm. Secondary pneumothorax is a continuation of a protracted lung disease.
The clinical manifestations of this symptom depend primarily on how quickly the air fills the pleural cavity. In most cases, a diagnosis can be made after examining the patient at the scene. Sometimes additional methods are requiredexaminations such as x-rays.
Treatment is usually surgical. It comes down to removing air from the chest cavity by drainage or puncture, restoring the function of the mediastinal organs and returning them to their places.
Communication with the external environment
The form distinguishes several variations of pneumothorax. The types of the disease depend on which side the hole formed (from outside or from the inside of the body), as well as on its size and the rate of gas flow.
- Closed pneumothorax is diagnosed when a small amount of gas enters the pleural cavity through a small hole that does not communicate with the external environment. The pressure in the chest cavity increases slowly, and the defect closes on its own, without additional help. The air bubbles gradually dissolve between the layers of the pleura, and the lung takes on its usual shape.
- Open pneumothorax develops under the condition of a penetrating wound of the chest wall or rupture of a large bronchus. Always communicates with the external environment. Because of this, the negative pressure in the internal cavity of the body equalizes with atmospheric pressure, from which the lung collapses, and air does not enter it.
Tensive or valvular pneumothorax appears only with a combined injury (chest wall injury with damage to the pleura and rupture of a large bronchus) and is characterized by the fact that air enters the body cavity on inspiration, but does not leave it on expiration. The pressure in the pleural cavity is first compared withatmospheric and continues to grow. As a result, the mediastinal organs are displaced and compressed
Pathogenesis
In order to competently provide assistance, you need to know how pneumothorax is formed, its types. The physiology of this process lies in the fact that normally the pressure inside the pleural cavity is negative. This helps to keep the lungs in a straightened state, and also accelerates gas exchange in the alveoli. When the tightness of the chest is broken, and atmospheric air begins to fill the pleural cavity, the lungs decrease in volume.
This interferes with normal inhalation, and as a result, the person begins to choke. In addition, the air compresses and pushes the mediastinal organs: the heart, aorta, esophagus, interfering with their direct functions.
Etiology
The type of pneumothorax depends on the traumatic agent. Etiology, types, pathogenesis, clinic and treatment are an inextricable logical chain, the knowledge of which can save a person's life, even if you are not related to the medical profession.
1. Spontaneous pneumothorax is a rupture of a large bronchus or lung parenchyma, not associated with mechanical damage to the chest. It is divided into two large groups:
- Primary, or idiopathic, occurs for no apparent reason. It is more common in young tall men than in women of the same age and build. This can be explained by the following features: pathological changes in the lungs due toa genetic defect in the synthesis of the alpha-1-antitrypsin enzyme, which is involved in the normal functioning of the alveoli; too thin pleura, which can tear from a slight pressure drop, for example, when coughing or sneezing; a sudden pressure drop when climbing mountains (mountain sickness) or diving underwater (caisson sickness).
- Secondary pneumothorax is caused by pre-existing lung conditions such as COPD (chronic obstructive pulmonary disease), cystic fibrosis and asthma.
2. The most common are cases of traumatic pneumothorax. Types of damage are divided into two categories: penetrating wounds of the chest cavity (cut, chopped wounds, open fractures of the ribs); blunt chest injuries (car injuries, crushing between stationary objects, falling from a height).
3. During medical procedures, the appearance of pneumothorax is also possible. In such cases, it is called iatrogenic. The dangers are biopsies of the lung or pleura, diagnostic punctures of the contents of abscesses and cysts, the installation of a subclavian catheter and barotrauma from mechanical ventilation (artificial lung ventilation).
Clinic
When questioning and examining the patient, the doctor pays attention to the sudden onset of chest pain, shortness of breath, rapid breathing and palpitations, dry cough. Acute attacks of fear may also be due to pneumothorax. Types of injuries and the nature of damage, sometimes detected even visually, will help to finally decide ondiagnosis and refer the patient for treatment. It can be both a surgical and a therapeutic hospital or an intensive care unit. It all depends on the severity of the condition and the specifics of the damage.
Diagnosis
As mentioned above, knowing the mechanism that caused pneumothorax, types and differential. diagnosis is not difficult. To do this, it is enough to conduct an external examination of the chest and auscultation of symmetrical sections of the lungs (to compare the he althy part with the diseased one). If it was not possible to identify the damage, then in order to be completely sure, it is necessary to send the patient for x-rays or computed tomography. Air does not reflect radioactive radiation, which means it will be clearly visible in the picture.
As an additional technique, you can use the determination of the gas composition of the blood (to determine whether there are sharp shifts towards hypercapnia), electrocardiography (to prevent complications in the form of cardiac arrest), and also resort to the consultation of a surgeon (usually this is done on stage of examination of the patient in the emergency department).
Emergency
Despite the different types of pneumothorax, first aid comes down to calling an ambulance. Since an unprepared person is unlikely to be able to cope with internal injuries, the experience of a trauma surgeon is needed here. The only thing that can be done in the case of an open variant of the disease is to apply a thick, airtight bandage to the wound. To do this, you can use oilcloth, plastic wrap orthick cotton-gauze swab. These manipulations will help form a closed pneumothorax.
Types, emergency first aid and elementary diagnosis of this disease should be included in the scope of knowledge of any person who has completed a civil defense (civil defense) course. Then he will be able to adequately assess the situation and make the right decision.
Treatment
First of all, you need to know exactly what kind of pneumothorax the patient has. If the amount of air between the pleural sheets is insignificant, then specific assistance may not be required. It will gradually dissipate on its own. In the case when the volume of gas prevents the lung from opening normally, it must be aspirated with a syringe by puncturing the pleural cavity. This will help to quickly eliminate pneumothorax. Types (emergency care depends on this) diseases matter because they require a different approach. A significant amount of damage may require the installation of a one-way Bulau drainage.
In addition, in case of massive injuries, the intervention of a surgeon is required to suture the lung parenchyma, defects of the pleura and bronchi, as well as close the penetrating wound of the chest.
As a symptomatic therapy, it is recommended to use painkillers and oxygen inhalation. If episodes of pneumothorax are repeated quite often, the patient may be advised to perform pleurodesis - soldering the pleura sheets together.
Complications andforecast
As after any illness, there are always consequences of a pneumothorax. Its types in this case play an insignificant role. In the first place among the complications is bleeding, or hemothorax. Behind him are pleurisy (inflammation of the connective tissue and the formation of adhesions between the sheets of the pleura) and subcutaneous emphysema (air entering the tissue under the skin). With a significant area of damage and untimely assistance, the patient may die.
Prevention
In order to prevent the development of pneumothorax, it is enough to follow a few simple rules:
- Timely and fully treat diseases of the respiratory system and prevent their complications, leading to the formation of weaknesses in the lungs and pleura.
- Give up bad habits, in particular smoking.
- Try to avoid chest trauma.
- Take steps to avoid recurrent pneumothorax.
