Pheumothorax
Description:
Pheumothorax (from other - Greek — whiff, air and — a breast) — accumulation of air or gases in a pleural cavity. It can spontaneously arise at people without chronic diseases of lungs ("primary"), and also at persons with diseases of lungs ("secondary"). Many pheumothoraxes arise after an injury of a thorax or as a treatment complication.
Symptoms of pheumothorax are defined by the size and speed of intake of air in a pleural cavity; the stethalgia and the complicated breath concern to them in most cases. The diagnosis can be exposed at physical inspection in certain cases, but the X-ray analysis of a thorax or the computer tomography (CT) is sometimes necessary. In some situations, pheumothorax results in heavy shortage of oxygen and lowering of blood pressure, progressing in a cardiac standstill in the absence of treatment; such state call a tension pneumothorax.
Small spontaneous pheumothorax is usually allowed independently and treatment is not required, especially in cases without associated diseases of lungs. At large pheumothorax or when there are heavy symptoms, air can be pumped out by means of the syringe or imposing of a unilateral drainage of Byulau, entered for removal of air from a pleural cavity. Surgical measures, especially are sometimes necessary if the drainage tube is not effective or there are repeated episodes of pheumothorax. Various methods of treatment, for example use of a pleurodesis (sticking of lungs in a chest wall), can be used if there is a risk of repeated episodes of pheumothorax.
Pheumothorax symptoms:
1. On communication with the environment distinguish:
* The closed pheumothorax. At this look a small amount of gas which does not accrue gets to a pleural cavity. The message with external environment is absent. It is considered the easiest type of pheumothorax as air potentially can resolve independently gradually from a pleural cavity, at the same time the lung finishes.
* Open pheumothorax. At open pheumothorax the pleural cavity is reported with external environment therefore in it pressure equal to atmospheric is created. At the same time the lung is fallen down as the major condition for a raspravleniye of a lung is negative pressure in a pleural cavity. The fallen-down lung is switched off from breath, in it there is no gas exchange, blood is not enriched with oxygen. Can be followed with a hemothorax.
* Valve pheumothorax. This type of pheumothorax arises in case of formation of the valve structure passing air in the unilateral direction, from a lung or from the environment in a pleural cavity, and interfering its exit back. At the same time with each respiratory movement pressure in a pleural cavity increases. It is the most dangerous type of pheumothorax as the irritation of nerve terminations of a pleura leading to plevropulmonalny shock and also shift of bodies of a mediastinum joins switching off of a lung from breath that breaks their function, first of all squeezing large vessels.
2. Besides, pheumothorax can be:
* Pristenochny (the pleural cavity contains a small amount of gas/air, the lung is not completely straightened; as a rule, it is the closed pheumothorax)
* Full (the lung which is completely fallen down)
* Sacculated (arises in the presence of the commissures between a visceral and parietal pleura limiting area of pheumothorax; is less dangerous, can proceed asymptomatically, but also can cause also additional ruptures of tissue of lung in the place of commissures).
Bilateral full pheumothorax at non-rendering of the help leads to a bystry lethal outcome because of critical disturbance of respiratory function.
The patient with pheumothorax feels a sharp stethalgia, breathes often and superficially, with an asthma. Feels "shortage of air". Pallor or cyanosis of integuments, in particular persons is shown. Breath on the party of damage is sharply weakened by Auskultativno, perkutorno — a sound with a bandbox shade. Hypodermic emphysema can be defined.
Pheumothorax reasons:
* Spontaneous (spontaneous) — at a rupture of air cells:
o primary — in the absence of clinically significant pulmonary pathology,
o secondary — a complication of the existing pulmonary pathology (tuberculosis, violent emphysema of lungs etc.).
* Traumatic — at injury of a thorax:
o the getting thorax injury,
o stupid injury of a thorax.
* Iatrogenic — a complication after medical or diagnostic intervention:
o after a puncture of a pleural cavity,
o after catheterization of the central veins,
o after a pleurocentesis and a biopsy of a pleura,
o after a transbronchial endoscopic biopsy of a lung,
o owing to a barotrauma.
Also pheumothorax can be caused intentionally, by introduction to a pleural cavity of gas or air, in particular, such technique was applied at treatment of a cavernous pulmonary tuberculosis.
Treatment of Pheumothorax:
At suspicion of pheumothorax it is necessary to call immediately the ambulance or to see a doctor. If open pheumothorax takes place, it needs to be turned in the occlusive dressing which is not passing the air closed by imposing ("occlusive bandage") on an open wound of a thorax. For example, it can be made by means of oil-cloth material or the unimpaired tight polyethylene film, also the thick wadded gauze bandage quite will approach.
Existence of precisely diagnosed valve pheumothorax demands transformation it in open pheumothorax for pressure decrease in a pleural cavity. For this purpose carry out a puncture of a pleural cavity a thick needle (in the 2nd mezhreberye on the median and clavicular line on the party of damage, on the upper edge of an edge).
The qualified help.
Treatment of pheumothorax consists in its elimination by suction of air from a pleural cavity and recovery in it negative pressure. At the closed pheumothorax without the existing message with easy for rather puncture aspiration of gas from a pleural cavity by means of set for elimination of pheumothorax in aseptic conditions of the operating room. If aspiration by a needle is inefficient, it demonstrates intake of air from lung tissue. In such cases carry out tight drainage of a pleural cavity ("a drainage across Byulau"), or create system of active aspiration, including using electrovacuum devices.
Open pheumothorax demands initial transfer in the closed pheumothorax (that is liquidations of the message with external environment by tight sewing up of a wound) then carry out the procedures of recovery of negative pressure mentioned above in a pleural cavity.
In the presence of unexploded bulls the decision on removal of a segment or lung lobe for prevention of developing of pheumothorax is made.
