What is pneumothorax and how to treat this disease?
Pneumothorax - what is it? First of all, it is a question of life or death for the injured person, and only emergency, emergency measures can prevent deaths. This condition occurs suddenly and is caused by the penetration of air into the part of the human body, where in principle it should not be. It is the understanding of the essence of this terrible phenomenon can save lives.
The features of pathology
Pneumothorax the lung is a sharply manifested pathology caused by penetration and concentration of the air mass in the lung the pleural cavity and is characterized by hazards such as compression of lung tissue, mediastinal shift and compression of its blood vessels, the movement of the dome of the diaphragm. These pathological damages cause rapid and severe impairment of respiratory capacity and blood circulation.
The essence of the problem lies in the emergence of severe pressure imbalance in the lungs. Physiologically normal pulmonary abbreviations provided by maintaining in the pleural cavity negative pressure. In contact and the accumulation of air masses in this zone, the pressure starts to rise, which causes natural compression effect on the lung tissue reducing their ability to make breathing movements.
This air infiltration can be caused by direct contact with an external atmosphere when an open wound or damage to other organs due to some disease or external intervention.
Pathology can occur suddenly or develop through gradual concentration of gases as a result of pathogenic processes. Severe complications are caused by excess pressure in the pleural cavity ventilation and significant pulmonary dysfunction. The consequence of illness is the falling of lung tissue leading to its collapse. Very dangerous manifestation of the disease is pneumothorax in newborns caused by abnormal birth.
The types of the disease
Classification of pneumothorax lung is based on the etiology and pathogenesis of the disease, and also taking into account the severity of the lesion. According to the etiological mechanism there are the following kinds: spontaneous, traumatic and iatrogenic (artificial). The nature of injuries pneumothorax is divided into open, closed and valve type. The open form of the pathology is determined in violation of the integrity of the skin and the presence of a direct path for the ingress of atmospheric air into the pleural cavity. The pressure in this cavityequalized with atmospheric pressure, which causes compression of the lung. When closed, the type of lesions direct contact of the pleural zone with the external environment is not, and in the cavity gas gradually accumulates, forming a gas bubble of limited capacity.
The valve type of the disease is largely similar to the closed form, but the pleural tissues are triggered to the valve mechanism: the gas goes in, but not released back. Thus, the concentration is increased in the cavity with each breath, which causes compression of the pathology of nerve processes, vessels, area of the mediastinum.
Given the location of the main damage to the disease is unilateral or bilateral in nature. One-sided (left - or right-sided) pneumothorax causing compression and damage to only one lung. Of bilateral form disrupts the functions of both bodies, which can result in complete respiratory arrest. The volume of infiltrated air are separated by a full or limited pneumothorax. The ability to lure in the other organs noted uncomplicated and complicated form. In the second case of possible serious effects: emphysema, pleural effusion, bleeding, etc.
The etiology of the phenomenon
Different reasons cause different forms of disease. Spontaneous pneumothorax is not dependent on mechanical effects, but is due to two causes: primary and secondary. Primary factors cause pneumothorax in children and young people under the age of 22-28 years. It affects:
- genetic predisposition (weakness of the pleural tissue, a deficiency of the enzyme alpha-1-antitrypsin);
- the acceleration of growth;
- bad habits (especially Smoking);
- a passion for deep diving;
- frequent changes in pressure (e.g. in the plane).
Secondary factors are primarily manifested at a later age. These include:
- lung disease (pulmonary fibrosis, sarcoidosis);
- respiratory disease (asthma, cystic fibrosis, COPD);
- infectious pulmonary lesions (tuberculosis, pneumonia);
- diseases of connective tissue systemic (polymyositis, scleroderma, dermatomyositis, rheumatoid arthritis).
Causes of traumatic type of disease become damage to pleural and pulmonary tissues with the defeat violation of the skin (open form) or internal organ damage. Injuries of a private nature arise as a result of falling from a height, severe blows (including accidents and natural disasters), closed fractures of ribs. Open injuries include gunshotwounds, cuts, punctures.
Iatrogenic nature etiology is associated with health effects. Most often, artificial disruption of the pleural integrity is observed when carrying out the following operations: installation of the Central catheter, the implementation of the ventilation of the lung, biopsy or puncture of the pleural cavity, resuscitation of the heart or lung.
Pneumothorax in newborns and infants stands out as a separate type of disease because of the specificity of the etiology. Pathology develops on the background of incomplete formation of tissue structures and the actions of ancestral factors. The main precipitating causes: the constant and hysterical cries, forced pulmonary ventilation, enlarged alveoli, congenital cyst. As generic factors may be the penetration of amniotic fluid into the respiratory channels during childbirth. Aggravate the situation of frequent falls.
Symptoms of pathology
The symptoms of pneumothorax are severe, appear suddenly and clearly. From experience the following symptoms: sudden severe pain in the chest, shortness of breath or severe shortness of breath, a dry, hysterical cough. The characteristic symptom of the disease (regardless of its form) is forced sitting the patient: pain and shortness of breath do not give him the opportunity to lie down. In the case of a partial nature, filling the pleural cavity pain syndrome decreases slowly, but remains a pronounced acceleration of heart rate and shortness of breath.
Traumatic internal damage manifests a marked deterioration of health: active shortness of breath (the frequency of the respiratory cycle is of the order of 45 per minute), there is a bluish discoloration of the skin, low blood pressure, palpitations. When you have an open wound, air bubbles rise with blood with each exhalation. The mass of air rushes into the subcutaneous area of the face, neck, chest, causing swelling. The most pronounced tumor is observed in the interval between the ribs.
Pneumothorax or valve is one of the most dangerous types of the disease. Its main symptoms are: severe sudden-onset shortness of breath, General weakness up to loss of consciousness, signs of hypertension. A terrible symptoms cause the patient a feeling of fear.
Treatment of pathology
Pneumothorax is a very life-threatening disease, and delay in starting treatment can result in tragedy. It is particularly important that timely emergency assistance, emergency treatment and further prevention of pneumothorax.
The primary task of emergency aid - stopping bleeding, and preventing direct contact of the pleural cavity with atmospheric air.
Whatit is necessary to make urgently? You need to conduct the following activities:
- providing poluciaetsea position with a light breath (the removal of all that interferes with breathing);
- overlay dense tight bandage on the affected area;
- the excretion from faint, administering pain medication (aspirin, analgin, etc.).
The sealed bandage is applied as follows: chest wrapped a soft dressing is placed on the sealant in the form of a polymer film on top of the bandage is sealed and sealed tight bandage or plaster.
Medical treatment of pneumothorax puts such purposes: elimination of the open channel, removing accumulated air from the cavity, restoring negative pressure in the pleural cavity, removal of pain syndrome and elimination of consequences of pathology. The first stage is the translation of the open form into a closed pneumothorax, i.e., sewing the wound with antibiotics, antiseptics. Removal of the air bubble produced by the puncture of the injured area via the midclavicular line in the layout area of the second intercostal space.
If the accumulated volume of gas in the pleura is significant, then entered the drainage system. In General, aspiration can be active or passive method. Active vacuum aspiration is carried out by using special devices. The passive method is usually carried out according to the method of Bühlau. Prevention of recurrence of pneumothorax is conducted by sclerosing therapy. In the pleural cavity are special products that ensure the bonding of fabrics, and fixed everything by electrocoagulation.