Description of pneumothorax: types of disease, causes, diagnosis and treatment
In many TV 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 the ambulance staff so accurately determine its availability, the amount of assistance and many other aspects of this issue remain behind the scenes. In this article you will find answers that help you navigate in a critical situation.
Pneumothorax is the accumulation of air or other gas in the chest cavity. Most often occurs after injuries as a result of open fracture of the ribs or injury of the lung to a fragment of bone, as well as a rupture of the lung abscess, opening of the bullae or melting of the bronchus wall by a malignant neoplasm. Secondary pneumothorax is a continuation of a protracted lung disease.
Clinical manifestations of this symptom depend primarily on how quickly the air fills the pleural cavity. In most cases, you can make a diagnosis after examining the patient at the scene. Sometimes additional methods of examination are required, for example, radiography.
Treatment is usually surgical. It reduces to the removal of air from the cavity of the thorax by drainage or puncture, the restoration of the function of the organs of the mediastinum and their return to their places.
Communication with the external environment
Several variations of pneumothorax are distinguished in form. The types of disease depend on which side the hole was formed( from the outside or from the inside of the body), as well as from its size and speed of gas supply.
- 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. Air bubbles gradually dissolve between the pleura sheets, 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 aligns with the atmospheric, from which the lung collapses, and air does not enter it.
- A strained, or valve pneumothorax appears only in case of a combined injury( injury of the thoracic wall with damage to the pleura and rupture of the large bronchus) and is characterized by the fact that air enters the body cavity on inhalation, but does not exhale from it. The pressure in the pleural cavity is first compared with the atmospheric and continues to grow. As a result, the organs of the mediastinum are displaced and squeezed.
In order to competently assist, it is necessary to know how pneumothorax forms, its types. The physiology of this process is that the normal pressure inside the pleural cavity is negative. This helps maintain the lungs in straightened condition, and also accelerates gas exchange in the alveoli. When the tightness of the chest is broken, and the atmospheric air begins to fill the pleural cavity, the lungs decrease in volume.
This prevents normal inhalation, and as a result, a person begins to suffocate. In addition, the air squeezes and pushes out the organs of the mediastinum: the heart, the aorta, the esophagus, interfering with the performance of their immediate functions.
The traumatic agent depends on what pneumothorax will be. Etiology, types, pathogenesis, clinic and treatment are an inseparable 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 parenchyma of the lung that is not associated with mechanical damage to the chest. It is divided into two large groups:
- Primary, or idiopathic, occurs for 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 tear from a slight pressure drop, for example, when coughing or sneezing;sharp pressure drop when climbing mountains( mountain sickness) or submerging under water( caisson disease).
- Secondary pneumothorax is formed against the background of already existing lung pathology, such as COPD( chronic obstructive pulmonary disease), cystic fibrosis and bronchial asthma.
2. The most common cases are traumatic pneumothorax. Types of damage are divided into two categories: penetrating injuries of the chest cavity( cut, chopped wounds, open fractures of the ribs);blunt injuries of the chest( auto-trauma, crushing between fixed objects, falling from height).
3. During the medical procedures, the appearance of pneumothorax is also possible. In such cases it is called iatrogenic. Danger is represented by lung or pleural biopsies, diagnostic puncture of the contents of abscesses and cysts, setting of a subclavian catheter and barotrauma from mechanical ventilation( artificial lung ventilation).
Clinic When a patient is questioned and examined, the physician draws attention to sudden pain in the chest, shortness of breath, rapid breathing and palpitations, dry cough. Acute attacks of fear can also be a consequence of pneumothorax. The types of injuries and the nature of damage, sometimes even visually detected, will help to finally determine the diagnosis and send the patient to treatment. It can be either a surgical or a therapeutic hospital or a resuscitation department. Everything depends on the severity of the condition and the specific damage.
As mentioned above, knowing the mechanism by which pneumothorax was caused, species and diff.diagnosis is not difficult. To do this, it is sufficient to perform an external examination of the chest and auscultation of symmetrical areas of the lungs( to compare the healthy part with the patient).If the damage was not found, then in order to be completely sure, it is necessary to send the patient to a radiography or computed tomography. Air does not reflect radioactive radiation, which means it will be clearly visible in the picture.
As an additional technique, it is possible to use the determination of the blood gas composition( to determine if there are sudden shifts towards hypercapnia), electrocardiography( to prevent complications in the form of cardiac arrest), and also to consult a surgeon( usually at the stage of examining the patient inreception room).
Despite the different types of pneumothorax, first aid is reduced to an emergency call. Since an unprepared person can cope with internal injuries, it is unlikely that he will need the experience of a trauma surgeon. The only thing that can be done in case of an open variant of the disease is to impose a thick hermetically sealed bandage on the wound. To do this, you can use oilcloth, polyethylene film or thick cotton-gauze swab. These manipulations will help to form a closed pneumothorax.
Species, emergency first aid and elementary diagnosis of this disease should be included in the knowledge of any person who has undergone the civil defense program. Then he will be able to adequately assess the situation and make the right decision.
First of all, you need to know exactly what kind 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 where the volume of gas prevents the lung from opening normally, it must be aspirated using a syringe by puncturing the pleural cavity. This will help to quickly eliminate pneumothorax. Types( emergency care depends on it), diseases are important because they require a different approach. A significant amount of damage may require installation of a one-way drain on the Bulau.
In addition, with massive injuries, surgeon intervention is required to suture the lung parenchyma, pleural and bronchial defects, and also to close the penetrating wound of the chest.
As a symptomatic therapy, it is recommended to use painkillers and inhalation of oxygen. If episodes of pneumothorax are repeated quite often, a patient may be recommended to perform pleurodesis - soldering the pleura sheets between them.
Complications and prognosis
As well as after any illness, there are always consequences of the transferred pneumothorax. His species play an insignificant role in this case. In the first place among the complications is bleeding, or hemothorax. He was followed by pleurisy( inflammation of the connective tissue and the formation of adhesions between the pleura sheets) and subcutaneous emphysema( air entering the cellulose under the skin).With a large area of damage and untimely care, the patient may die.
In order to prevent the development of pneumothorax, it is sufficient to observe several simple rules:
- Timely and fully treat respiratory system diseases and prevent their complications leading to weaknesses in the lungs and pleura.
- Refuse bad habits, in particular - from smoking.
- Try to avoid chest trauma.
- Take measures to avoid repeated pneumothorax.