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Pneumothorax lung

Pneumothorax is a disease the name of which comes from two Greek words, pneuma and thorax (air and chest). An acute condition occurring in our day often enough, is the concentration in the pleural cavity of air. The victim needs immediate medical assistance.

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What is a pneumothorax the lung?

Pneumothorax the lung is a life-threatening pathology, in which the air penetrates the place where it is normal to not be in the pleural cavity.

The air being in the pleural cavity that could cause lung collapse with partial or full form. The development of the disease can be spontaneous or occur in connection with already present in human lung disease, wounds, medical manipulations. The ventilation function of lungs is violated, they are compressed, there is a deficiency of oxygen, respiratory failure. The organs of the mediastinum (great vessels, heart) are shifted, there was a failure of the processes of circulation.

What are the different types of pneumothorax?

The presence/absence of communication with the environment divides the disease into the following varieties:

  • Open. Occurs depressurization of the respiratory system. Through the hole in the chest air leaks into the pleural cavity during inspiration, leaves when you exhale, its accumulation does not happen. The pressure is negative, leads to the fact that slight decreases, ceases to participate in the respiratory process, the gas exchange it is terminated, stops the flow of oxygen in the blood.
  • Closed. In the pleural cavity is a certain amount of gas, its volume remains stable, as the acquired defect is closing fast. If the air leaves the cavity itself (which is very likely with a closed wound), concise easy lines, the respiratory processes are normalized. This species is considered to be the easiest.
  • Valve. The shift of the mediastinum, disruptions of their functioning, pleuropulmonary shock are the perils that threaten the patient with this form of the disease called the most severe. The appearance of the valve structure causes the airconcentrated in the pleural cavity, without leaving it, increasing pressure. The air penetrates through the wound.

Depending on join if complications, are referred to as the following types of the disease.

  • Uncomplicated. Complications do not develop the disease.
  • Complicated. The accession of complications: emphysema, hemorrhage, pleurisy and so on.

Depending on the type of distribution of a pneumothorax may be unilateral or bilateral:

  • One-sided. The patient is spadenie one light – left or right.
  • Bilateral. The patient has a compression of both lungs. This pathological condition is a serious threat to life, the patient requires emergency assistance.

Moreover, the pneumothorax volume of air may be complete, parietal, osmawani.

  • Full. In this case, it is easy to subside completely. If the patient has complete bilateral pneumothorax, it is in need of emergency assistance. Otherwise, a critical failure of the respiratory functions can cause death.
  • Parietal. A small amount of air fills the cavity of the pleura, the lung expanded completely. (Basically it is a closed form).
  • Summany. Adhesions between the parietal and visceral pleura restrict the area of the pneumothorax. Sometimes symptoms are absent, a special hazard kind is not, however, theoretically can cause tearing of lung tissue in the area of adhesions.

Pneumothorax in all its forms is not a purely "adult" problem, with the disease face even babies just born. In young children the disease can occur for many reasons, raises a number of unique symptoms, but doctors fight with her just as they treat adults.


Causes of pneumothorax

Iatrogenic, traumatic, spontaneous – the so-called main groups of reasons why a patient may develop this condition.

Spontaneous pneumothorax

Pathology, in which there is a breach of integrity pleura, filling its cavity with air. If the patient does not receive any external injuries. Depending on the causes may be primary or secondary in nature.

The occurrence of primary pneumothorax is not obvious reasons. Highgrowth, being male, 20-30 years old, the presence of harmful habits (cigarettes) – these are the main risk factors. Rarely the disease occurs after the age of 40 are also less likely to suffer are women.

To produce spontaneous pneumothorax following diseases and pathologies:

  • genetically caused weakness of the pleura, in which rupture enough laughter, coughing, physical stress;
  • congenital lack of the enzyme alpha-1-antitrypsin, causing pathological processes in the lungs;
  • travel by plane (pressure drop), diving, Snorkelling.

Secondary spontaneous pneumothorax develops in Association with pulmonary pathology. It can be:

  • lung disease, traumatic connective tissue (sarcoidosis, lymphangioleiomyomatosis, idiopathic pulmonary fibrosis, tuberous sclerosis);

  • malignant tumors (lung cancer, sarcoma);
  • respiratory diseases (cystic fibrosis, bronchial asthma, severe COPD);

  • infectious lung disease (abscess of the lung, tuberculosis, pneumonia on a background of HIV);

  • systemic connective tissue disease including lung involvement (dermatomyositis, rheumatoid arthritis, systemic sclerosis, polymyositis, Marfan syndrome).

In most cases with this disease are faced in old age is 60-65 years.

Iatrogenic pneumothorax

The main source of this form of various medical manipulations. To intensify disease can:

  • setting venous (Central) catheter;
  • ventilation of the lungs;
  • biopsy of the pleura;
  • puncture of the pleural cavity;
  • cardio-pulmonary resuscitation.

Traumatic pneumothorax

Injuries, chest injuries – is the main source of this form of the disease:

  • closed chest injury received by falling from heights, fights and so on (traumatic rupture of the lung, damaged by pieces of broken ribs without compromising the integrity of the skin);
  • a penetrating chest wound (gunshot, stab wounds, causing the rupture of the lungs).

Pneumothorax in newborns

Pneumothorax – an anomaly, which often appears in young children, newborn babies.

Causes of pneumothorax inchildren could be next.

  • Reinforced the crying leads to rupture of pleural adhesions.
  • Gap acquired or congenital cysts.
  • Forced pulmonary ventilation.
  • The genetic pathology of the lungs causes rupture of emphysematous alveoli expanded.
  • Rupture of lung abscess.

Most often the occurrence of this disease in a child is associated with genetic malformations of the lung and pleura (wrong structure), injuries and inflammation. Sometimes activating factor is birth asphyxia, rupture of lung tissue of a baby happens with the forced artificial respiration. Pneumothorax can occur as a result of clogging of the respiratory tract amniotic fluid or mucus.


The symptoms of pneumothorax

Pneumothorax may manifest itself by other symptoms, their appearance depends on particular type of disease, severity of its course, the presence/absence of complications and other factors.

  • Sudden onset of shortness of breath – the patient has shortness of breath superficial, it is hard for him to breathe.
  • Sharp pain in the area of the chest is activated when you inhale, sharp; it is also possible to return to the shoulder of the injured party.
  • Attacks of dry cough.
  • The patient takes a forced position (semi-sitting, sitting).
  • A feeling of weakness, fear, increased heart rate, lowering blood pressure.

  • The performance of the sticky cold sweat on the skin.
  • Subcutaneous emphysema – air enters when you exhale in the subcutaneous fatty tissue pressing on the swelling appears noise like crunching on snow.
  • Lividity of the skin is a symptom occurs when expressed failure processes of circulation, respiration.
  • The allocation of the "foam" of the blood from the wound (open pneumothorax).

The symptoms of spontaneous pneumothorax

Almost all patients diagnosed with primary spontaneous pneumothorax, telling doctors about chest pain, manifested from the defect, abruptly appeared shortness of breath. Varies the intensity of the pain is from very strong to minimal. Most patients describe it as sharp first, and then as dull or aching. The clinical picture lasts no more than a day, regardless of, whether treateddisease.

A patient with spontaneous secondary pneumothorax, he is sure there is shortness of breath regardless of how much air was in the pleural cavity. Most often appears and pain lokalizirutesa from the affected side. Probably, the accession of hypoxemia, hypotension.

The symptoms of valvular pneumothorax

The patient is in an excited state, complains of a sharp pain in his chest. Pain can be stabbing or knife-like character, is given in the scapula, shoulder, abdomen. Instantly develop weakness, cyanosis, shortness of breath, it is likely a faint.

The symptoms of pneumothorax in infants

Symptoms of a pneumothorax in babies under a year can look like the following:

  • the appearance of puffiness of the face;
  • tachycardia;

  • lividity of the skin;
  • anxiety, excited state;
  • difficulty breathing, shortness of breath;
  • the appearance on the torso, neck subcutaneous crepitate.

Consequences pneumothorax

Complications of pneumothorax, according to statistics, there are approximately 50% of patients.

  • Inflammation of the pleura (pleurisy). May be accompanied by the occurrence of adhesions that violates the expansion of the lung.
  • Getting into the cellular tissue of the mediastinum of air, compression of large vessels of the heart.
  • Intrapleural bleeding.
  • Subcutaneous emphysema – a condition in which the air is in the subcutaneous fat.
  • Death. Possible in severe cases, penetrating chest wound, a large amount of damage.

Emergency treatment of pneumothorax

Pneumothorax in the valve or open form belongs to a number of emergency conditions, upon the occurrence of which should immediately call an ambulance. Then, be sure to perform the following steps:

  • to stop the process of filling air in the pleural cavity of a person;
  • to stop the bleeding.

You will need to put a sealed tight bandage. In an emergency situation in the absence of sterile tools need to use improvised stuff – shirt, t-shirt. Theclean section is applied to the wound. For sealing wounds on top of the makeshift bandage superimposed plastic bag (plastic film).

You should also simplify the patient, the breathing process, for which they should be placed in an elevated position. All actions are performed very carefully, so as to cause the victim additional pain. If a person faint, be sure to bring it to life. If ammonia is not at hand, will fit any vehicle having a pungent odor, for example, gasoline, perfume, liquid varnish remover. The tool next to the nose.

The last task is to prevent the development of pain shock, this will help banal aspirin or analgin. Having given first aid, you should wait for the paramedics to arrive.


Treatment of pneumothorax

Pneumothorax is life-threatening, so the healing process starts even before arrival to the hospital.

On the way to the hospital

  • Anesthesia. If the patient concerned about the excruciating pain, he entered narcotic analgesics omnopon, morphine. If expressed pain are absent, it is possible to get a analgin.
  • Oxygen therapy.
  • The removal of the cough reflex. For deliverance of the patient from the cough, use cough medicines – libeksin, codeine, tusupreks.
  • Pleural puncture. This procedure becomes a necessity, if the patient's condition is rapidly deteriorating (rapid drop in blood pressure, increased shortness of breath) caused by a valvular pneumothorax. Puncture can make not only a doctor but a paramedic.

Treatment in a hospital

Patients with pneumothorax subject to compulsory hospitalization. Medical treatment consists in puncture of the pleural cavity, the removal of the air, forming negative pressure in the pleural cavity. Treatment depends on the form of the disease.

Conservative expectant treatment is relevant if we are talking about a closed confined small pneumothorax. The patient the rest, are introduced painkillers. If necessary, use needle system is carried out by air aspiration. Thoracentesis is done on the side of the injury at the midclavicular line in the second intercostal space.

In the case of total form to prevent shock reactions and a quick straightening of the lung in the pleural cavity is drainage, followed by active (using the vacuum device) or passive (in.) aspiration of air.

The first task inan open pneumothorax – a translation of it in private. To do this, the wound is sutured, penetration into the pleural cavity air stops. This is followed by manipulations similar to those carried out in closed form.

If the victim has a tension pneumothorax requires decompression within the pleura. First, make it open with the help of puncture, followed by surgical treatment.

Recurrent spontaneous pneumothorax, bullous emphysema provoked, treated surgically.

Anesthesia

Pain relief is important point in combating pneumothorax, analgesics required by the patient and the stage of atelectasis, and when it is straightened. To prevent the recurrence of the disease is pleurotes silver nitrate, talc, glucose solution and other sklerosiruuschem drugs. So in the pleural cavity deliberately stimulated adhesions.

Rehabilitation and prevention

After leaving the hospital, the patient suffered a pneumothorax, need for 3-4 weeks to refrain from any physical activity. Grounded on the plane for 2 weeks after treatment. Should not engage in parachute jumping, diving – all this causes pressure differences. It is strictly forbidden to smoke, you should quit this dangerous habit. Doctors also suggest screening for tuberculosis, COPD.

Methods of prevention, able to turn into reliable protection from pneumothorax, unfortunately, does not exist, however some actions still to take:

  • Quitting Smoking.
  • Screening for lung diseases and their timely treatment.
  • Conducting an adequate amount of time in the fresh air.
  • Breathing exercises.

Pneumothorax is not a sentence most people who successfully cope with it. Uncomplicated forms of the disease with timely treatment of a guarantee of a favorable outcome, but not the absence of danger of relapse.

According to statistics, primary spontaneous pneumothorax back to the man in approximately 30% of cases, most often it occurs in the first six months after treatment. Relapse rates in the case of secondary spontaneous pneumothorax is even higher – 47%.

The sooner the patient, who showed signs of pneumothorax will be taken to the hospital, the greater the chances of successful recovery.