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Pneumothorax: causes, symptoms, first aid and treatment

Pneumothorax is a life-threatening condition requiring emergency medical care. Acute pathology often accompanies injuries of the chest, including gunshot and accident, and can also occur due to lung disease or as a complication of some medical procedures.

Pneumothorax of the chest is easy to suspect without instrumental examination. Knowledge of the symptoms of the condition will help to promptly seek qualified help and the preservation of human life.

Content

Pneumothorax - what is it?

What is pneumothorax

A bit of anatomy. The lungs are covered with pleura, consisting of two sheets. There is no air in the pleural cavity, so the pressure in it is negative. This fact determines the work of the lungs: straightening during inhalation and collapse during exhalation.

Pneumothorax is a pathological entry of air into the pleural cavity due to its depressurization due to external injury, pulmonary disease, and other causes.

At the same time, intrapleural pressure increases, preventing the lungs from straightening while inhaling. Partially or completely collapsed lung is turned off from the breathing process, blood circulation is disturbed.

The lack of timely assistance most often leads to the development of complications that threaten the life of the patient.

Causes and types of pneumothorax

air entering the pleural cavity, photo 2

air entering the pleural cavity, photo 2

Depending on the provoking factor, the following types of pneumothorax are divided:

  • Traumatic

The rupture of pleural sheets occurs with open injuries (stabbing, gunshot) and closed injuries (pleural damage with a broken rib, a blunt blow to the chest, while maintaining the integrity of the skin).

  • Spontaneous

The main cause of spontaneous pneumothorax is the rupture of pulmonary vesicles in bullous disease. The mechanism of the occurrence of emphysematous expansions of the lung tissue (bull) has not yet been studied.

However, this disease is registered in most healthy people, especially after 40 years. Also, a spontaneous rupture of the inner leaflet of the pleura and lung occurs in congenital weakness of the pleura, cavernous tuberculosis, and abscess / gangrene of the lung.

  • Iatrogenic

Damage to the lung with the development of pneumothorax is often a complication of some medical procedures: the installation of a subclavian catheter, puncture of the pleura, blockade of the intercostal nerve, cardiopulmonary resuscitation (barotrauma).

  • Artificial

The intentional creation of pneumothorax is resorted to with the spread of pulmonary tuberculosis and for diagnostic thoracoscopy.

Also pneumothorax determine the following indicators:

  • according to the degree of damage to the respiratory system - unilateral and bilateral;
  • depending on the degree of lung collapse: small or limited - less than 1/3 of the lung is off of breathing, 1/3 - 1/2 is average, and more than half of the lung is total;
  • by the nature of the air entering the pleura: closed - the volume of air that came once does not increase, open - there is a direct communication of the pleural cavity with the environment, and the volume of incoming air constantly increases until the lung collapses, the most dangerous stressful (valve) pneumothorax - a valve is formed air passing in the direction of the environment - the pleural cavity and closing its exit;
  • depending on the complicating consequences - complicated and uncomplicated.

Spontaneous pneumothorax

If other types of pneumothorax of the lungs have a well-defined external cause, spontaneous pneumothorax can occur even in a healthy person who does not have a history of injury or lung disease. Idiopathic (primary) pneumothorax occurs in the following situations:

  • sudden pressure drops during air travel, diving;
  • genetic weakness of the pleura - rupture of the lung tissue and pleural sheet can provoke laughter, physical stress (including straining with constipation), severe coughing;
  • congenital deficiency of alpha-1-antitrypsin - provokes the development of pathological changes in lung tissue.

Secondary spontaneous pneumothorax, caused by the development of pulmonary disease, occurs in pathologies:

  • damage to the respiratory tract - cystic fibrosis, chronic obstruction of the lungs , emphysema, severe bronchial asthma;
  • connective tissue diseases affecting the lungs - sarcoidosis , pneumosclerosis , lymphangioleiomyomatosis;
  • infections - abscess, gangrene, tuberculosis, as well as ordinary pneumonia in HIV-infected;
  • systemic diseases occurring with damage to the lungs - systemic scleroderma, rheumatoid arthritis, polymyositis;
  • oncopathology of the lungs.

Symptoms of pneumothorax

Symptoms of pneumothorax

The development of pneumothorax is always sudden, the severity of the symptoms depends on the degree of lung collapse and the presence of complications.

6 main signs of pneumothorax:

  1. Breathing problems - dry cough, shortness of breath, breathing becomes shallow.
  2. The pain is sharp, aggravated by inspiration, radiating to the shoulder from the side of the injury.
  3. Subcutaneous emphysema - occurs when the outer layer of the pleura ruptures, exhalation air enters the subcutaneous tissue, and swelling with crepitation (snow crunch) is externally detected when pressed on it.
  4. Foaming blood released from a wound is characteristic of open pneumothorax.
  5. External signs - forced sitting posture, pallor and blueness of the skin (indicating a developing circulatory and respiratory failure), cold sweat.
  6. Common symptoms - increasing weakness, panic, rapid heartbeat, a / d drop, fainting possible.

First aid for pneumothorax

When the symptoms of pneumothorax occur, the only correct tactic is:

  1. Immediate emergency call and emergency hospitalization.
  2. Normal sterile dressing with open pneumothorax. Incorrectly applied occlusive dressing can lead to strained pneumothorax and rapid deterioration. Therefore, its imposition is carried out only by a physician.
  3. Perhaps the introduction of Analgin (tablets, in / m injection).

Applying an occlusive dressing for pneumothorax:

  • Soothe the patient by explaining the sequence of actions.
  • Perhaps the use of Promedol for pain relief.
  • Observance of sterility when opening packages with tools and dressing material, use of sterile gloves.
  • The position of the patient is a slightly raised arm on the injured side. Applying the bandage is made on the exhale.
  • Layering of cotton-gauze discs on the wound, hermetic packaging with sterile side to the wound and completely covering the pads applied to the wound, tight bandaging.

Diagnostics

  1. Percussion (tapping) - “boxed” sound on the side of pneumothorax.
  2. Auscultation (listening) - weakening of the breath on the affected side until its absence.
  3. X-ray - air in the pleura (dark spot), collapsed lung, with the development of intense pneumothorax - mediastinal shift to a healthy side.
  4. CT scan not only reveals even small volumes of air in the pleura, but also clearly defines the causative disease.

Additional diagnostic examinations include laboratory analysis of the blood gas component and ECG (determines the degree of circulatory disorders in the form of tense pneumothorax).

Treatment of pneumothorax

After a spontaneous pneumothorax with a limited amount of incoming air, there are usually no serious consequences. Even without treatment, small "air" pillows in the pleural cavity can self-dissolve, without giving marked clinical symptoms. However, medical supervision of such a patient is necessary.

In other cases, surgery is required:

  1. Closed pneumothorax - puncture of the pleural cavity and air pumping. The ineffectiveness of this tactic indicates the flow of air into the pleura through the lungs. In this case, Bulau drainage or active aspiration with electrovacuum equipment is applied.
  2. Open pneumothorax - an operation with an opening of the chest (thoracoscopy, thoracotomy) and a revision of the lung tissue and pleura, suturing damage, the installation of drainage.

If during the operation, unexploded bullae are detected, in order to avoid recurrent pneumothorax, a decision is made to resect a segment / lobe of the lung, the procedure for creating artificial pleurisy (pleurodesis).

Forecast

Uncomplicated forms of spontaneous pneumothorax usually end favorably. The outcome of an acute condition with significant lung collapse depends on the speed of medical care provided, as after 4-6 hours inflammation begins to develop. Also relapses are not excluded.

Immediate surgery is required for valvular pneumothorax.

Effects

  • Pleurisy and purulent empyema with subsequent formation of adhesions and secondary respiratory failure.
  • Intrapleural bleeding.
  • Compression of the heart and coronary vessels with air trapped in the mediastinum, development of acute heart failure.
  • Mortal danger with a large amount of damage and deep injury of lung tissue.

Pneumothorax - ICD code 10

The international classification of diseases ICD 10 pneumothorax is:

Section X. J00-J99 - Respiratory Diseases

J93 - Pneumothorax

  • J93.0 - Spontaneous tension pneumothorax
  • J93.1 - Other spontaneous pneumothorax
  • J93.8 - Other pneumothorax
  • J93.9 - Pneumothorax, unspecified

Additionally:

  • S27.0 - Traumatic pneumothorax
  • P25.1 - Pneumothorax arising in the perinatal period
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