In many series about doctors and detectives, we often find words whose meaning we understand poorly or do not understand at all. For example, pneumothorax. What is this disease? Symptoms, signs by which ambulance officers 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 that will help you navigate in a critical situation.
Definition
Pneumothorax is the 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 a wound to the lung with a bone fragment, as well as a rupture of the lung abscess, opening of the bulla or melting of the bronchus wall with a malignant neoplasm. Secondary pneumothorax is a continuation of a protracted lung disease.
The clinical manifestations of this symptom depend primarily on how quickly air fills the pleural cavity. In most cases, a diagnosis can be made after examining the patient at the scene. Additional examination methods, such as radiography, are sometimes required.
The 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 environment
The shape distinguishes several variations of pneumothorax. The types of disease depend on which side the hole formed (from the outside or from the inside of the body), as well as its size and the rate of gas entry.
- Closed pneumothorax is diagnosed in cases where 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 itself, without additional help. Bubbles of air gradually dissolve between the leaves of the pleura, and the lung takes 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 is aligned with the atmospheric, from which the lung falls off, and air does not enter it.
- Tense or valvular pneumothorax appears only with a combined trauma (wound of the chest wall with damage to the pleura and rupture of the large bronchus) and is characterized by the fact that the air enters the body cavity on inspiration, but does not exit it on exhalation. The pressure in the pleural cavity is first compared with atmospheric and continues to grow. As a result, the mediastinal organs are displaced and compressed.
Pathogenesis
In order to properly provide assistance, you need to know how pneumothorax is formed, its types. The physiology of this process is that the pressure inside the pleural cavity is normal. This helps to maintain 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 prevents a normal breath, and as a result, a person begins to suffocate. In addition, air compresses and forces out the organs of the mediastinum: heart, aorta, esophagus, interfering with the performance of their immediate functions.
Etiology
The type of pneumothorax also 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 profession of a doctor.
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 without obvious reasons. It is more common in young tall men than in women of the same age and complexion. This can be explained by the following features: pathological changes in the lungs due to a genetic defect in the synthesis of the enzyme alpha-1-antitrypsin, which is involved in the normal functioning of the alveoli; too thin pleura, which can break from a slight pressure drop, for example, when coughing or sneezing; a sharp pressure drop when climbing into the mountains (mountain sickness) or immersion under water (decompression sickness).
- Secondary pneumothorax is formed against the background of an existing lung pathology, such as COPD (chronic obstructive pulmonary disease), cystic fibrosis and bronchial 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 danger is biopsy of the lung or pleura, diagnostic puncture of the contents of abscesses and cysts, staging of the subclavian catheter and barotrauma from mechanical ventilation (mechanical ventilation).
Clinic
When interviewing and examining a patient, the doctor draws attention to a sudden chest pain, shortness of breath, rapid breathing and palpitations, dry cough. Acute attacks of fear can also be the result of pneumothorax. Types of injuries and the nature of injuries, sometimes even visually detected, will help to finally determine the diagnosis and refer the patient for treatment. It can be either a surgical or therapeutic hospital or a resuscitation unit. It all depends on the severity of the condition and the specifics of the damage.
Diagnostics
As mentioned above, knowing the mechanism by which pneumothorax was caused, species and differential. Diagnostics are 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 healthy part with the patient). If it was not possible to identify the damage, then in order to be completely sure, it is necessary to send the patient for radiography 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 changes in the direction of hypercapnia), electrocardiography (to prevent complications in the form of cardiac arrest), and also seek the advice of a surgeon (usually this is done at the examination stage of the patient department).
Urgent Care
Despite the different types of pneumothorax, first aid is reduced to calling an ambulance. Since an unprepared person can cope with internal injuries, he is unlikely to be able to, 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 put a thick tight dressing on the wound. To do this, you can use oilcloth, plastic wrap or a thick cotton-gauze swab. These manipulations will help form closed pneumothorax.
Types, emergency first aid and elementary diagnosis of this disease should be included in the knowledge of any person who has completed a course of civil defense (civil defense). 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 type of pneumothorax the patient has. If the amount of air between the pleural leaves is insignificant, then specific assistance may not be required. He himself will gradually resolve. In the case when the volume of gas prevents the lung from opening normally, it must be aspirated with a syringe by puncture of the pleural cavity. This will help to quickly eliminate pneumothorax. The types (emergency care depends on this) of the disease are important because they require a different approach. A significant amount of damage may require the installation of unilateral drainage according to Bulau.
In addition, with massive injuries, the intervention of a surgeon is required to suture the lung parenchyma, pleural and bronchial defects, and also close the penetrating chest wound.
Anesthetics and oxygen inhalations are recommended as symptomatic therapy. If episodes of pneumothorax are repeated quite often, the patient may be advised to perform pleurodesis - soldering the pleura sheets together.
Complications and prognosis
As after any disease, there are always consequences of pneumothorax. Its species in this case play an insignificant role. In the first place among the complications is bleeding, or hemothorax. Behind it are pleurisy (inflammation of the connective tissue and the formation of adhesions between the pleura sheets) and subcutaneous emphysema (air entering the fiber under the skin). With a significant area of damage and untimely care, 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.
- Refuse bad habits, in particular - smoking.
- Try to avoid chest injuries.
- Take measures to avoid repeated pneumothorax.