The first and urgent aid in case of pneumothorax
Pneumothorax, emergency which is simply necessary, is a very serious disease. Of right decisions at times human life depends. Only the emergency intervention of people nearby capable of stopping the development of a very dangerous process in the respiratory system, and this person should know how to carry out basic life-saving activities.
When suddenly emerged pneumothorax, first aid should be carried out urgently before the arrival of the ambulance. Especially the severity of the problem relates to traumatic types of pathology that can occur away from the housing when the ambulance arrived takes time. This suggests that the knowledge of how to conduct first aid in cases of pneumothorax, it is necessary for all.
Features of pneumothorax
Pneumothorax represents the concentration of the air in the cavity of the external sheath of the lung (the pleural cavity). In the normal state of the respiratory process is provided with the negative pressure in this cavity, but with the accumulation of gas the balance is disturbed, leading to respiratory failure and impaired lung function. The air can enter from the outside when open contact with the environment (trauma) or from other organs in the destructive pathology.
Types of pneumothorax
Its etiology pneumothorax is divided into spontaneous, traumatic and iatrogenic (artificial).
The spontaneous form is the result of damage to the inner chest piece that provides a flow of air into the cavity of the lung. Causes: pathology of the lung structure of a complication of diseases (abscess, tuberculosis, emphysema), leading to accumulation of air in the lungs, which the destruction of the wall of the pleural cavity run into it. Predisposing factors: strained cough, sudden movement, stress.
Traumatic type occurs when an open wound or a closed chest injury that damages lung tissue or blood vessels.
Iatrogenic etiology nature provides complications or conscious action of medical orientation. Such a process may occur after puncture of the cavity, the use of Central venous catheter, pleural biopsy, endoscopic biopsy of the lung.
On the pathogenesis of and communication with the external environment pneumothorax is divided into the following types:
- Closed pneumothorax: the pleural cavity gets a limited amount of air, which is notincreases in future because of the lack of contact with the environment; it is considered the easiest for pathology: the bladder is gradually resorbed and deformed lung returns to its size.
- Open pneumothorax: the direct contact of the cavity with the surrounding air, causing it pressure, equal to atmospheric; if open pneumothorax the lung shrinks and is unable to perform its respiratory function – increases in respiratory distress, impaired gas exchange, blood is evident oxygen deficiency (can develop hemothorax).
- A tension pneumothorax: valve mechanism is formed when the air passes into the pleural cavity, but can not go back – with every breath the pressure in the cavity is increased; in the pathological process included irritable reaction of the nervous processes of the pleura (possible development pleuropulmonary shock), shifts the mediastinal organs, damage to major blood vessels.
Separately allocated a tension pneumothorax, when manifested severe oxygen deficiency and reduced blood pressure, can cause serious heart abnormalities, until the heart stops. This type is often the development of valvular pneumothorax.
The symptoms of the disease
To emergency treatment of spontaneous pneumothorax was provided in a timely manner, you need to focus on the following characteristic symptoms: the sudden appearance of a dagger piercing pain in the chest, shortness of breath (dyspnea), dry cough. The main symptom of all types of pneumothorax – forced adoption victims sitting position (the patient is unable to take the supine position). With a limited volume of the bladder of the closed type, the pain gradually diminishes, but persists tachycardia and shortness of breath.
In the case of the traumatic nature of the disease is rapidly deteriorating General condition of the patient, there is an obvious shortness of breath during the respiratory rate of 40 per minute, there is a blue discoloration of the skin, decreased blood pressure, tachycardia manifested. If you have an open wound from it stand out when you exhale the air bubbles with the blood. The air is distributed in the subcutaneous area of the face, neck, chest, causing swelling, especially in the intercostal spaces.
The most dangerous kind of valve is manifested as sudden severe breathlessness, lividity of the face, General weakness until he lost consciousness. There is a fear, a marked hypertension.
First aid to the patient
When there are obvious signs of pneumothorax, first aid can save a life. The first necessary step – the callemergency medical care. Without waiting for the arrival of the doctor should first aid.
The main task – to stop the bleeding and to exclude direct contact of the pleural cavity with air.
Assistance is provided in the following order:
- It is necessary to give the victim a semi-sitting position to facilitate breathing.
- The overlay is sealed tight bandage to prevent bleeding and air infiltration. A bandage is applied as follows: first, the wound is placed a soft material (bandage, cloth, fabric), and then the sealing layer (plastic film, rubber sheet), all sealed tight bandage with a bandage or plaster.
- If the patient is unconscious, you must revive him (smelling salts, Cologne, body lotion, nail Polish, etc.).
- Relief of pain with analgesic (aspirin, analgin).
Emergency medical assistance
Urgent professional assistance in such areas as the conversion to the closed form of pneumothorax, the gas removal and the restoration of negative pressure in the pleural cavity, relief of pain and pain relief, elimination of the negative pressure, the elimination of complications.
The translation in closed form is performed by professional suturing open wound, which eliminates the contact of the cavity with the surrounding air. In valvular form of pathology of the first excision of the valve structure through surgery, and then transfer to the closed state.
If there is a significant reduction in arterial blood pressure, respiratory failure, it is urgent puncture of pleural cavity by introducing a thick needle into the gap between 2nd and 3rd rib on the midclavicular line. This procedure is performed under local anesthesia with novocaine. At the same time provide pain relief by intravenous injection of dipyrone or tramal.
Emergency measures in a hospital
A patient with pneumothorax is delivered in resuscitation unit of hospital which accept urgent measures on elimination of pathology. First and foremost ensured by the drainage of the pleural cavity to remove the air. Permanent aspirinbuy drainage is carried out by means of a tube with a diameter of about 5 mm, introduced into the cavity through an incision in the intercostal space. The end of the tube connects with the suction. Complete drainage is usually within 1-2 days afterstraightening lung. If the drainage cavity does not lead to a positive result, surgery is performed to eliminate the defect and restore the integrity of the pleura.
To avoid subsequent recurrence of pneumothorax is applied sclerosing therapy. To do this in the pleural cavity are administered drugs that cause irritation stenoses tissue in order to close it. After research with the help of thoracoscopy and establish the etiology of the phenomenon are necessary medical interventions: glue tissue sclerotherapy, electrocoagulation, etc.