Human life is priceless and fragile. Anyone can find themselves in a situation where they need emergency help. And it’s good if at a critical moment there are people nearby who know what to do in a given situation. Of course, qualified medical assistance is irreplaceable and must be provided without fail. But there are stories where you have to act even before the ambulance arrives. Otherwise, the person may die. One of the most dangerous complications of the respiratory system, which poses a threat to human life, is pneumothorax.
This pathology does not occur at every step, but calling it rare would also be incorrect. A dangerous condition is characterized by the accumulation of air in the area of pleural tissue.
First aid for spontaneous pneumothorax of the lung and treatment
Pneumothorax is a life-threatening condition characterized by the presence of air in the pleural cavity.
Pneumothorax can be spontaneous (spontaneous), iatrogenic and traumatic. The consequences of traumatic pneumothorax include: hemothorax, recurrent pneumothorax and the formation of pneumomediastinum. Depending on the connection with the environment, open, “tension” (valvular) and closed pneumothorax are distinguished. Open is characterized by “depressurization” of the respiratory system due to a chest injury. The normal pressure in the lung changes, which leads to its “sticking together” and the cessation of gas exchange. Symptoms of closed pneumothorax include sharp chest pain, inability to breathe normally, rapid heartbeat, and cold sticky sweat. With valve pneumothorax, air passes in one direction - into the pleural cavity and cannot escape back - the valve “triggers”. Valvular pneumothorax is characterized by compression of the lung and large vessels, irritation of the nerve endings of the pleura, which can cause respiratory failure. Possible causes of pleural pneumothorax:
- infectious diseases (tuberculosis, Pneumocystis pneumonia);
- pathologies of the respiratory system (cystic fibrosis, asthma, obstructive pulmonary disease);
- connective tissue diseases (scleroderma, rheumatoid arthritis, polymyositis);
- thoracic endometriosis;
- oncological diseases;
- chest injuries;
- closed chest injuries;
- complex diagnostic and therapeutic measures.
Treatment of open pneumothorax is carried out exclusively in a hospital setting. Emergency care for pneumothorax is provided in an ambulance.
General information
Pneumothorax is an accumulation of air in the pleural cavity, which leads to collapse of the lung with subsequent displacement of the mediastinum to the healthy side.
The dome of the diaphragm lowers and the vessels of the mediastinum are compressed, which negatively affects the functioning of the cardiovascular and respiratory systems. As a result of pneumothorax, gas can enter between the layers of the parietal and visceral pleura through any defect in the chest or on the surface of the lung. After air enters the pleural cavity, the pressure inside the pleura increases (it should be below atmospheric pressure), which leads to partial or complete collapse of the lung. ICD-10 code: J93 Pneumothorax.
Intestinal pneumothorax is mistakenly confused with pneumatosis intestinalis , which is characterized by the appearance of cysts containing gases or air.
Clinical manifestations of pathology
Symptoms depend on the type of pneumothorax and the degree of compression of the lung. The disease begins suddenly.
General symptoms:
- sticky cold sweat;
- shallow breathing;
- cyanosis of the skin;
- sharp chest pain, rapid heartbeat;
- weakness, decreased blood pressure;
- subcutaneous emphysema;
- an attack of dry cough is a sign of a tension pneumothorax;
- fear;
- the patient takes a forced position to alleviate the condition.
The further condition and life of the patient largely depends on the correct actions at the stage of providing first aid for spontaneous pneumothorax of the lung.
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Main signs of the condition
It is really important not to miss signals that a person is developing pneumothorax! Indeed, in such a situation, minutes can count.
The following manifestations may indicate the presence of the condition in question:
- Acute sharp and very severe pain behind the sternum.
- Shortness of breath.
- The occurrence of a dry, deep cough.
Typically, a person who has developed a dangerous pathology takes a characteristic sitting position. As a rule, the inability to lie down and take any other position indicates the presence of this particular problem.
Associated symptoms include changes in complexion (blue discoloration, unhealthy redness), profuse sweating, dizziness, and loss of consciousness. With some types of pneumothorax, the neck and sternum of a person take on unnatural shapes (swell, swell). The venous artery in the neck area is blown out. The patient's pupils are dilated. A person may feel panic and an uncontrollable fear of death. Excessive sweating, tremors of the limbs, unnatural paleness of the skin may indicate the development of shock.
Emergency care for pneumothorax in newborns
Pneumothorax in newborns is a severe pathology that is currently extremely rare. The most complex form of the disease is spontaneous pneumothorax. The causes of the disease can be: genetic pathology of the lungs, rupture of a cyst, rupture of a lung abscess.
Main symptoms: shallow breathing, anxiety, overexcitement, shortness of breath. Symptoms increase quickly, within 2-3 hours.
Emergency care for pneumothorax in newborns before the ambulance arrives: place the baby in an extended position so that the diaphragm and chest are free, and turn the baby’s head to the side.
Tests and diagnostics
In critically ill patients, pneumothorax can be diagnosed based on information from the medical history and physical examination. The patient registers:
- severe chest pain;
- rapid increase in shortness of breath ;
- hypotension;
- rapid heartbeat, tachycardia ;
- contralateral displacement of the trachea;
- pulsus paradoxus;
- reduction in the severity of breathing sounds.
All of the above signs are not highly specific and characteristic exclusively of pneumothorax. In secondary spontaneous pneumothorax, the severity of shortness of breath does not correspond to the scale of pneumothorax, and latent emphysema may be the cause of weakened breathing.
Acute changes in ventilation parameters, such as an increase in airway pressure or a decrease in tidal volume, can either be associated with pneumothorax or be a manifestation of another pathology. This is why chest X-ray remains the gold standard for diagnosing pneumothorax.
Radiography
On a radiograph, the main sign of pathology is an area of clearing, which is located along the peripheral edge of the pulmonary field and separated by a clear boundary from the collapsed lung. The area is devoid of pulmonary pattern. X-ray examination reveals the communication between the environment and the pleural cavity.
The main radiological sign of pneumothorax is an area of clearing, devoid of a pulmonary pattern, located along the periphery of the pulmonary field and separated from the collapsed lung by a clear boundary corresponding to the image of the visceral pleura. X-ray examination can reveal the connection of the pleural cavity with the external environment.
With open pneumothorax, during inspiration there is an increase in the gas bubble, collapse of the lung and subsequent displacement of the mediastinal organs to the unaffected side. The diaphragm dome moves downwards.
With a closed form of pneumothorax, the picture on the radiograph depends on the amount of gases collected in the pleural cavity and the level of intrapleural pressure. If the volume of air in the pleural cavity is small and the pressure is below atmospheric, and the lung is only slightly collapsed, then on exhalation it collapses, and on inhalation it increases in volume.
If the pressure is higher than atmospheric pressure, then the lung will sharply collapse, its respiratory excursion will be barely noticeable, and the mediastinal organs will also shift to the healthy side, the diaphragm will descend downwards. If atmospheric and intrapleural pressure are equal, then the lung collapses only partially, while the respiratory excursion is maintained and the mediastinal organs shift only slightly to the healthy side.
With valvular pneumothorax, the configuration of the collapsed lung in the act of breathing and its size do not change. The lung completely collapses, allowing the organs of the mediastinum to sharply shift to the healthy side, and on exhalation, partially return to the affected area. With prolonged injection of gases into the pleural cavity during valve pneumothorax, tension pneumothorax is formed. A sharp shift of the mediastinum to the healthy side is recorded, the diaphragm thickens and descends, air may appear in the soft tissues of the chest.
With total pneumothorax, air fills the entire pleural cavity, the shadow of the mediastinum fills the entire unaffected side, and the dome of the diaphragm moves downward.
When examined in a lateral position, even a small accumulation of gas can be detected. On the affected side, deepening of the costophrenic sinus, flattening and smoothing of the contours of the lateral, lateral surface of the diaphragm are recorded. If blood enters the pleural cavity along with air, a picture of hemopneumothorax with the formation of a horizontal boundary between the two environments.
CT scan
Thanks to this method, it is possible not only to confirm the diagnosis, but also to assess the size of the pneumothorax and the condition of the lung parenchyma. The study helps to differentiate the pathology from bullous diseases , which helps prevent improper drainage and the formation of a parenchymal-pleural fistula. Thanks to CT, latent pneumothorax has become more frequently diagnosed, which does not manifest itself clinically and is not detected by radiography. The incidence of hidden pneumothorax in patients with polytrauma reaches 64%, and in the general population ranges from 2-15%.
Ultrasound of the chest
Ultrasound examination is the most accessible diagnostic method. The method has several advantages compared to computed tomography and radiography:
- the ability to examine the patient at the bedside;
- no radiation;
- visualization of images in real time;
- the ability to assess the dynamic development of the process.
Ultrasound is considered the most sensitive and specific method in diagnosing lung collapse compared to radiography, since it can be used to assess the reexpansion of the lung after thoracostomy drainage. A significant disadvantage is the need for training in correct visualization and interpretation of results by the attending doctor, who does not work as a radiologist in his main specialty.
With subcutaneous emphysema, ultrasound waves penetrate very poorly into the chest. The method is considered extremely useful when it is necessary to exclude pulmonary collapse after catheterization of the central vessels and pleural procedures, eliminating the need to delay portable radiography.
Treatment of open pneumothorax
First aid before the arrival of the ambulance consists of applying a bandage to cover the opening in the chest. For this purpose, a thick bandage made of gauze and cotton wool or a cellophane bandage is used.
Qualified assistance in a hospital setting: puncture, air evacuation and restoration of negative pressure in the pleura. Important: both at the stage of emergency care and in a hospital setting, it is necessary to use painkillers to reduce the patient’s suffering.
Symptoms of pneumothorax of the lungs
With all forms of valvular pneumothorax, a typical clinical picture is observed, characterized by the development of severe life-threatening disorders of respiratory and circulatory functions.
The patient's condition deteriorates very quickly, and characteristic symptoms of pneumothorax appear:
- motor excitement;
- increasing expiratory shortness of breath with difficult and prolonged exhalation;
- cyanotic mucous membranes and skin;
- uneven, rapid breathing with intermittent inhalation and pain in the chest.
In this case, breathing sounds are sharply weakened, in some cases they are not heard at all.
Breathing and shortness of breath acquire a specific, peculiar character. The patient tries to hold his breath while inhaling, because... when exhaling, the chest decreases in volume and compression of the already compressed lungs occurs, both on the affected and healthy sides. There is an increase in blood pressure followed by a rapid decrease.
The pulse is tense at the initial stages, then becomes rapid with weak filling. There is marked smoothness of the intercostal spaces on the affected side and a slight excursion of the chest.
When hemothorax is attached, a box sound will be detected by percussion. Obstruction of venous outflow is evidenced by strongly pronounced and dilated veins in the neck. A sharply noticeable air emphysema , which can affect the head, neck, limbs and the entire torso. To assess the dynamic course of the process, a chest X-ray is performed.
Prognosis and prevention
With timely assistance, the outcome of the disease is favorable. The prognosis for traumatic pneumothorax depends on the nature of the damage to the chest organs. In any case, the patient will need a long recovery period under the supervision of a doctor. Relapses of the pathology are possible only in patients with severe diseases of the respiratory system. In this case, the patient is recommended to undergo preventive examinations by a pulmonologist with the necessary studies.
Preventive measures include timely treatment of diseases of the respiratory system and clinical observation in the presence of chronic lung pathology.
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Pathogenesis
Primary spontaneous pneumothorax occurs as a result of rupture of subpleurally located emphysematous bullae, which are formed against the background of congenital defects of elastic pulmonary structures or against the background of cysts that have developed abnormally in their terminal bronchioles.
Until now, the pathogenesis of bullae formation remains unknown. It is believed that they are formed as a result of the degradation of elastic fibers in the lungs, which is caused by the activation of macrophages and neutrophils due to smoking. There is a shift in the balance between antiproteases, proteases and the antioxidant oxidation system. Formed bullae provoke inflammatory blockage of the small airways, which leads to an increase in intra-alveolar pressure and air enters the pulmonary interstitium.
The air moves towards the root of the lung, causing emphysema . Due to increased pressure in the mediastinum, the parietal mediastinal pleura ruptures with the development of pneumothorax. Increased intrapleural pressure prevents fluid from leaking into the pleural cavity.
As a result of a large primary spontaneous pneumothorax, a sharp decrease in the vital capacity of the lungs occurs, an increase in the alveolar-arterial oxygen gradient with the subsequent development of hypoxemia of varying severity. Hypoxemia develops against the background of ventilation-perfusion imbalance and the formation of a shunt from right to left. The clinical picture will directly depend on the severity of these disorders. Maintaining normal gas exchange does not allow the development of hypercapnia .
Rupture of lung tissue can occur in the area of pleural fusion during forced breathing or coughing. Secondary spontaneous pneumothorax develops when a pathological focus breaks into the pleural cavity in people suffering from destructive diseases of the pulmonary system ( lung gangrene , lung abscess , tuberculosis cavity , pulmonary infarction ). A similar process can occur in patients with histiocytosis X , neoplastic diseases of the mediastinum and lungs, chronic obstructive diseases ( bronchial asthma ).
Most often, right-sided pneumothorax is recorded, much less often - bilateral.
Procedures and operations
Pleural puncture with manometry allows us to clarify the type of spontaneous pneumothorax. Intrapleural pressure indicators with closed spontaneous pneumothorax are positive or slightly negative. In the open form of pneumothorax they tend to zero, in the valvular form they tend to increase and are positive.
The aspirated fluid obtained as a result of puncture from the pleural cavity is sent to the laboratory to study the cellular composition and analyze the microflora . Thoracoscopy is performed to determine the size and location of the pleural fistula.
Danger of pneumothorax
Provided that competent medical care is provided in a timely manner and there is a sufficient amount of rehabilitation measures, pneumothorax in most cases has a favorable prognosis. Death with this pathology occurs only with the development of an extensive tense valvular form, which is accompanied by a disorder of central hemodynamics and severe hypoxia.
Among the most common life-threatening complications of pulmonary pathology are:
- exudative pleurisy (fluid accumulates in the pleural cavity);
- pleural empyema (infectious inflammation is associated);
- rigid lung (the lung cannot expand due to the formed connecting cords);
- acute respiratory failure;
- anemic syndrome (hemoglobin level drops sharply);
- hemopneumothorax (blood rushes into the pleural cavity).
According to statistics, these complications develop in 50% of patients diagnosed with pneumothorax.
Prevention of pneumothorax
There are no specific methods for preventing pneumothorax. Necessary:
- timely treatment for lung diseases;
- be examined for the presence of nonspecific lung diseases, tuberculosis;
- stop smoking;
- spend more time outdoors;
- do breathing exercises.
People who have had the disease are advised to avoid physical activity. Immediately after surgery to eliminate the pathology, you cannot fly on an airplane, dive, or parachute for two weeks. It is important to prevent chest injury.
This article is posted for educational purposes only and does not constitute scientific material or professional medical advice.
Causes of pneumothorax
Pneumothorax is provoked by two groups of reasons:
- Mechanical damage to the lungs/chest.
- Diseases of the chest and lungs.
The first includes:
- closed chest injuries, which are accompanied by damage to the lungs from rib fragments;
- complications resulting from diagnostic/therapeutic measures (iatrogenic);
- open chest injuries;
- artificial pneumothorax, carried out for diagnostic (thoracoscopy) or therapeutic (pulmonary tuberculosis) purposes.
Diseases that cause pneumothorax of the lung include:
- rupture of caverns, breakthrough of caseous foci in tuberculosis;
- rupture of air cavities during bullous disease, spontaneous rupture of the esophagus (intestinal pneumothorax), rupture of a lung abscess into the pleural cavity (pyopneumothorax).
