Closed pneumothorax symptoms. Pneumothorax: what is it? Causes, symptoms and treatment of pneumothorax. Causes and types of disease

Pneumothorax- the presence of air in the pleural cavity between the chest wall and the lung, caused by a wound of the chest wall or lung with damage to one of the bronchus branches. The disease usually occurs between the ages of 20 and 40.

Causes of pneumothorax:

closed injury chest: damage to the lung by fragments of ribs;
open chest trauma: penetrating wounds;
iatrogenic injuries (complication after therapeutic or diagnostic intervention): lung injury when trying to catheterize the subclavian vein, acupuncture, blockade of the intercostal nerve, pleural puncture;
spontaneous pneumothorax;
nonspecific pneumothorax: rupture of the bullae (focal bullous emphysema), cysts, breakthrough of a lung abscess in pleural cavity(pyopneumothorax), spontaneous rupture of the esophagus;
tuberculous pneumothorax: rupture of the cavity, breakthroughs of caseous foci;
artificial pneumothorax is applied with therapeutic purpose with pulmonary tuberculosis, with diagnostic for thoracoscopy, for differential diagnosis of chest wall formations.

Types of pneumothorax:

Closed pneumothorax

A certain amount of gas enters the pleural cavity, which does not increase. There is no communication with the external environment, so its flow stops. It is considered the easiest type of pneumothorax, since the air can potentially gradually dissolve from the pleural cavity on its own, while the lung expands.

Open pneumothorax

The presence of a hole in chest wall, freely communicating with the external environment, therefore, a pressure equal to atmospheric pressure is created in the pleural cavity. At the same time, the lung collapses, since the most important condition for the expansion of the lung is negative pressure in the pleural cavity. The collapsed lung is switched off from breathing, gas exchange does not occur in it, the blood is not enriched with oxygen.

Valvular ("tense") pneumothorax

Progressive accumulation of air in the pleural cavity. Occurs in the case of the formation of a valve structure that allows air to pass in one direction, from the lung or from environment into the pleural cavity, and preventing its exit back. Air enters at the moment of inhalation, and at the moment of exhalation, without finding an exit for itself, it remains in the pleural cavity. Valvular pneumothorax is characterized by a triad: positive intrapleural pressure, leading to the exclusion of the lung from breathing, the attachment of irritation of the nerve endings of the pleura, leading to pleuropulmonary shock; persistent displacement of the mediastinal organs, which disrupts their function, primarily squeezing large vessels; acute respiratory failure.

Depending on the volume of air in the pleural cavity and the degree of collapse of the lung, a complete and partial pneumothorax is distinguished.
Bilateral complete pneumothorax, if left untreated, leads to rapid lethal outcome due to critical respiratory failure.

Symptoms of pneumothorax

The disease begins acutely after physical exertion, coughing fit or without visible reasons with a sharp stabbing pain in the chest, radiating to the neck, upper limb, sometimes in the upper half of the abdomen, aggravated by breathing, coughing or chest movements, shortness of breath, dry cough. The patient breathes often and superficially, there is severe shortness of breath, feels "lack of air." Paleness or blueness (cyanosis) skin in particular faces.

With an open pneumothorax, the patient lies on the side of the injury, tightly pressing the wound. When examining the wound, air suction noise is heard. Foamy blood may come out of the wound. Chest movements are asymmetrical.

Complications of pneumothorax:

Occur frequently (up to 50% of cases). These include: intrapleural bleeding due to tearing of the lung tissue, serous-fibrinous pneumopleurisy with the formation of a "rigid" lung (the formation of mooring - cords from connective tissue excluding expansion of the lung), pleural empyema ( purulent pleurisy, pyothorax). With valvular ("tense") pneumothorax, subcutaneous emphysema may develop (accumulation of a small amount of air under the skin in the subcutaneous fat).
In 15 - 50% of patients, recurrences of pneumothorax are observed.

Treatment of pneumothorax:

Prehospital stage. When providing first aid, the patient should be given a semi-sitting position with support for the back or put him down, raising the head end of the stretcher, open the window, unfasten the clothes and waist belt. With valvular tension, it is important to reduce intrapleural pressure. To do this, the pleural cavity is punctured and at least 500-600 ml of air is removed. The aspiration needle is usually inserted into the 2nd intercostal space along the midclavicular line. Sometimes, immediately after the puncture, a Seldinger pleural microdrainage (a catheter for the subclavian vein) is inserted, a system is connected to it for intravenous infusion and the tube is lowered into a vial with a liquid (for example, furacilin). With each deep breath and cough, air bubbles through the liquid. During transportation, the bottle is placed below the level of the patient's back.

hospital

Analgesics are administered, antitussives are prescribed. With effective drainage of the pleural cavity, passive straightening is carried out using a water shut-off valve, incl. and according to Bulau, especially when large volume air (a method of removing fluid and air from the pleural cavity using tubular drainage, introduced by puncturing the chest wall with a trocar and acting on the principle of communicating vessels). As active methods are used aimed at the constant or periodic removal of air and pleural fluid using systematic punctures or constant active aspiration with Goncharov or Lavrinovich-Kanshin devices. For a patient with SP, the optimal place for installing active drainage is the IV-V intercostal space along the midaxillary line. After the lung is straightened, the patient must stay on active drainage for at least 2-3 days for the defect to heal and the pleura sheets to stick together. If pneumothorax persists, it is not advisable to continue aspiration after 5 days due to the risk of infection of the pleural cavity. In this case, an open thoracotomy with suturing of the defect of the visceral pleura is indicated. Surgical methods (5-15%) include suturing of lung tissue defects, destruction and excision of adhesions and air bubbles, decortication of the lung or parietal pleurectomy, as well as resection of the affected lung.

Closed pneumothorax is a partial or complete collapse of the lung as a result of air entering the pleural cavity, but not from the external environment through a defect in the chest wall, but from the inside through damaged lungs and bronchi. This most often happens when closed injuries chest or destructive pathologies of the lungs. This condition requires urgent medical care, since it can lead to pronounced respiratory failure and lethal outcome.

Pneumothorax develops when air enters the pleural cavity. If this happens due to the resulting communication of the cavity with the environment, they speak of an open pneumothorax.

In the case of a closed pathology, there is no such message; air enters the pleural space from the lungs. At the same time, pressure in the pleural cavity increases, as a result of which the lung collapses partially or completely.

There are small (limited), medium and total pneumothorax, depending on the degree of collapse and exclusion of the organ from breathing.

Closed pneumothorax is a relatively favorable variant of the disease compared to open or valvular. However, if a total collapse or bilateral lesion occurs, this disease threatens the rapid development of respiratory failure, which can lead to death.

What causes such a pathology

Most often, the development of pathology is caused by injuries of the chest (for example, a fracture of the ribs, which led to a rupture of the lung) and diseases accompanied by destruction of the lung tissue.

These pathologies include:

bronchiectasis;
chronic obstructive bronchitis;
tuberculosis;
bullous emphysema;
pneumosclerosis;
cystic fibrosis;
tumor processes;
malformations, etc.

All these diseases can lead to secondary pneumothorax. But sometimes this disease develops initially, without previous pathology from the lungs or injuries. This is facilitated by various predisposing factors - connective tissue diseases, autoimmune pathologies, long-term smoking, premature age in children.

Also, closed pneumothorax can occur as a complication of medical manipulations, in particular, artificial lung ventilation, surgical interventions in this area.

Development mechanism

Normal pressure in the pleural cavity is negative. This contributes to the complete expansion of the lungs. When there is a violation of the integrity of the pleura, and air enters the cavity, the pressure begins to increase, which leads to a collapse of the lung to one degree or another.

In classical closed pneumothorax, the amount of air in the pleural cavity after admission remains constant, does not increase, and the pressure does not progressively increase. The defect in the pleura is tightened. If the volume of gas that has penetrated into the cavity is small, it gradually resolves, and the lung expands. These conditions usually do not require any treatment.

In the case of valvular pneumothorax, air enters the pleural cavity with each breath, but does not exit back. The pressure increases and the lung is compressed and collapses more and more.

This pathology requires emergency medical care, as it can quickly lead to severe respiratory failure incompatible with life.

Clinical picture

Symptoms of pathology depend on the volume of air that has entered the pleural cavity.

In the case of a limited lesion, no manifestations may occur, and the patient learns about the problem that has arisen by chance during a routine medical examination or does not know at all. This is not scary, since such a pathology does not require treatment and is resolved on its own.

Table 1. Stages of pneumothorax:

With average and total pneumothorax clinical picture develops suddenly and begins with the appearance sharp pains in the chest, which may radiate to the neck or arm. In parallel, the patient has a feeling of lack of air and shortness of breath.

Since blood circulation is disturbed in the affected lung, due to which oxygen enrichment of the blood suffers, arterial pressure the patient's pulse drops and quickens. Outwardly, pallor of the skin and acrocyanosis (blue nose, lips, fingertips) attract attention. When air enters the subcutaneous fatty tissue, subcutaneous emphysema can be seen.

With valvular pneumothorax, all symptoms rapidly increase. The patient is in a forced position to facilitate breathing, greedily catches air with his mouth, often experiences panic conditions from fear of suffocation. If measures are not taken in time, this condition threatens the development of respiratory and heart failure, collapse and death.

Diagnostics

characteristic clinical symptoms allow suspecting pneumothorax at the stage of questioning and examining the patient. On auscultation of the lungs, the doctor hears weakened breathing from the side of the lesion, and on percussion - a boxed sound. Palpation allows you to determine the lagging of one side of the chest during breathing, and if subcutaneous emphysema occurs, to identify a characteristic crunch.

Confirm the diagnosis with x-rays. When conducting this study, the mediastinum is displaced to one side and the accumulation of gas in the pleural cavity. What does a pneumothorax look like? x-ray shown in the photo below.

AT difficult cases to clarify the diagnosis, pleural puncture and thoracoscopy are used. You can learn more about the diagnosis of closed pneumothorax from the video in this article.

Treatment

Small closed pneumothorax does not require treatment. Usually patients do not notice its occurrence. Even if a violation is detected during the examination, a small amount of air will gradually resolve on its own, so you should not panic.

In all other cases, emergency medical intervention is necessary.

Attention! If a pneumothorax is suspected, call as soon as possible. ambulance. This can be done by calling 103, 112 (a single number for calling all emergency services), 911 (the number of the rescue service in the United States, but dialing it anywhere in the world triggers a connection to the nearest police station or rescue service).

While waiting for the ambulance, the patient needs to be reassured, helped to take a comfortable position, to ensure the flow fresh air(open windows).

hospital therapy

An ambulance hospitalizes the victim in the department of surgery or pulmonology. There he will be able to provide complete peace and qualified treatment. With minor violations and a small amount of air in the pleura, if there is no new intake, the treatment can be conservative.

In order to relieve the patient's symptoms, the doctor will prescribe antitussive and pain medications. Oxygen therapy is used to reduce respiratory failure. In case of noticeable cardiovascular insufficiency carry out appropriate treatment after consultation with a cardiologist.

To eliminate air from the pleural cavity, a pleural puncture is used - a puncture of the pleura with a long needle with a tube. As a result of the release of all the accumulated gas to the outside, negative pressure will be restored in the pleural cavity, which will allow the lung to straighten out and return its functionality. Such measures will help to stop all the symptoms and provide the pleural membrane with rest to restore the defect in it.

If, after the puncture, the symptoms reappear, it means that air continues to enter the pleural cavity. In such cases, a sealed drainage according to Bulau is installed. It has a valve, due to which it does not allow the reverse flow of air from the environment into the body.

In some situations, all of the above measures are not effective. Then you need to look for a source of air entering the pleural cavity. To do this, they resort to thoracoscopy, with the help of which they find and eliminate a defect in the pleura.

open surgical intervention(thoracotomy) - an extreme measure for closed pneumothorax. It is resorted to if there are no other options left, when hours or minutes count, and the cost of delay may be equal to death.

Forecast and prevention

The prognosis for closed pneumothorax is generally favorable. At timely diagnosis and treatment manages to remove all the air from the pleural cavity and stop all symptoms. Relapses of this disease are almost never found. Exception - chronic diseases lungs with destructive disorders.

No specific prevention pneumothorax does not exist. You should try to avoid traumatic sports and recreation, treat lung diseases in time, and stop smoking.

In some cases (with a superficial location of the bullae and bronchiectasis), the instruction recommends that preventive operations be performed to remove the affected areas of the lung tissue adjacent to the pleura.

Closed pneumothorax is an acute pathology requiring immediate medical attention. You can't try to fix it on your own. The main task of relatives of patients in this case- Get the patient to the hospital as soon as possible. The best way to do this is with a specialized ambulance.

Pneumothorax- accumulation of air or gases in the pleural cavity. It can occur spontaneously in people without chronic lung disease ("primary"), as well as in people with lung disease ("secondary"). Many pneumothoraxes occur after a chest injury or as a complication of medical treatment. The reasons: closed chest trauma with rupture of lung tissue, penetrating wound with rapid gluing of the chest wall wound and continuing gaping of the bronchus wound. Closed pneumothorax is a complication of chest trauma and is an indisputable sign of rupture of the lung or (more rarely) bronchus. It can be observed simultaneously with subcutaneous emphysema. Rupture of the lungs occurs as a result of direct injury by fragments of a broken rib or (less often) a sharp tension of the lungs in the region of the roots at the moment of impact on the ground when falling from a height. It can also be observed when a pedestrian is thrown onto the pavement when hit by a car moving at high speed. A patient with pneumothorax experiences a sharp pain in the chest, breathes quickly and shallowly, with shortness of breath. Feeling short of breath. Paleness or cyanosis of the skin, in particular the face, is manifested. Auscultatory breathing on the side of the injury is sharply weakened, percussion - a sound with a box shade. Subcutaneous emphysema may be present.

First aid. At the scene: anesthesia, cardiovascular drugs, semi-sitting position. When transporting: elevated position of the head end of the stretcher, oxygen inhalation. In severe general condition and indisputable signs of tension pneumothorax, it is necessary to make a puncture in the II - III intercostal space along the midclavicular line. After making sure that air enters through the needle into the syringe under pressure with a continuous stream, the needle is connected to a tube from a disposable system, at the end of which a valve is made from a finger from a glove. The tube is lowered into a vial with furatsilin. With tension pneumothorax, air bubbles are visible, released from the tube and passing through furatsilin. The end of the needle protruding above the skin of the chest wall is wrapped with adhesive tape and it is also attached to the chest wall.

Qualified help The treatment of pneumothorax consists in its elimination by sucking air from the pleural cavity and restoring negative pressure in it. In case of closed pneumothorax without an active connection with the lung, puncture aspiration of gas from the pleural cavity using a set to eliminate pneumothorax under aseptic conditions of the operating room is sufficient. If aspiration with a needle is ineffective, this indicates the intake of air from the lung tissue. In such cases, hermetic drainage of the pleural cavity (“drainage according to Bulau”) is performed, or an active aspiration system is created, including the use of electrovacuum devices.

Task 1 Fracture treatment method- YES THE FUCK KNOWS THIS OLD FARTER. Treatment. Anesthesia, reposition, mobilization, osteosynthesis.

Task 2. Crash syndrome. X-ray. Treatment urgent hospitalization, cold. Next, the pain is relieved through blockades. To improve microcirculation, combat shock and acute renal failure, infusion therapy is performed. For detoxification and improvement of microcirculation, glucose 5%, HES are administered. As a symptomatic therapy, antiarrhythmics, analgesics, diuretics. From surgical methods treatment is fasciotomy.

Ticket 3 1.Classification of fractures.

Fracture (fractura) called a violation of the integrity of the bone.

1. CLASSIFICATION

1. By origin fractures are divided into congenital (intrauterine) and acquired.

All acquired fractures by origin are divided into two groups: traumatic and pathological.

Traumatic fractures occur in initially intact bone.

Pathological fractures occur when exposed to a much smaller force (sometimes when turning in bed, resting on a table, etc.).

2. By the presence of damage to the skin fractures are divided into open and closed.

Gunshot fractures constitute a special group. Their feature is massive damage to bones and soft tissues. Often damaged arteries, veins, nerves.

3. By the nature of the damage bone fractures can be complete or incomplete.

When the fracture extends to the entire diameter of the bone, the fracture is called complete. They are more common.

Incomplete fractures include fissures, a subperiosteal fracture in children of the "green twigs".

4. Line direction fracture distinguish transverse, oblique, longitudinal, comminuted, helical, impacted, compression and avulsion fractures.

In addition, each type of fracture usually corresponds to a specific mechanism of injury. a helical fracture occurs when the limb is twisted, its rotational movement with the immobility of the proximal or distal part. An avulsion fracture occurs when there is excessive contraction or tension in a specific muscle group.

Compression - with a powerful impact along the axis.

5. Depending on the presence of bias( dislocation ) of bone fragments relative to each other, fractures are without displacement and with displacement.

The displacement of bone fragments can be:

By width ,

By lenght ,

at an angle ,

rotary .

6. Depending on the section of the damaged bone fractures can be diaphyseal, metaphyseal and epiphyseal. Epiphyseal fractures are almost always intra-articular.

7. By quantity fractures can be single or multiple.

8. By difficulty injuries of the musculoskeletal system distinguish between simple and complex fractures.

Simple fractures are fractures in which there is a violation of the integrity of only one bone.

9. Depending on the development of complications distinguish between uncomplicated and complicated fractures.

Possible complications of fractures:

traumatic shock

Damage to internal organs,

vascular damage,

fat embolism,

Wound infection, osteomyelitis, sepsis.

10. If there is a combination of fractures with injuries of a different nature, they speak of a combined injury or polytrauma. Examples of combined injuries:

Fractures of the bones of the lower leg on both limbs and rupture of the spleen;

Shoulder fracture, dislocation hip joint and brain injury.

According to the nature of communication with the external environment, open and closed pneumothorax are distinguished. A special variety is valvular, tense (tension) and spontaneous pneumothorax.

Open pneumothorax

Symptoms of open pneumothorax. Open pneumothorax is characterized by the entry of air into the pleural cavity through defects in the chest, as a result of which the lung on the side of the wound is in a compressed state, which is accompanied by a violation pulmonary ventilation. During inhalation, air enters the opposite healthy lung both from the external environment and from the lung on the side of the lesion. When exhaling, part of the air from a healthy lung enters the collapsed lung, contributing to its expansion. Gradually, this nature of breathing leads to anoxic hypoxia. In its development, a significant role belongs to the discharge of blood from pulmonary arteries into the veins, bypassing the capillary bed, where gas exchange occurs, through arteriovenous shunts that do not function normally. At the same time, constant irritation of the pleura receptors is accompanied by a neuro-reflex disorder. pulmonary-cardiac activities, mediastinal flotation. Developing changes in the state of the patient's body often lead to death.

Diagnostics. Plain radiograph of the chest on the side of the lesion reveals massive darkening, collapse of the lung.

Treatment of open pneumothorax. As a first aid to the injured, an airtight bandage is applied to the defect in the chest wall. Surgical intervention includes primary surgical treatment wounds, sanitation of the pleural cavity, suturing of a defect in the chest wall, pleural cavity. AT postoperative period intensive therapy is carried out, aimed at the prevention of purulent complications.

Closed pneumothorax

The leading symptom of a closed pneumothorax is the accumulation of air in the pleural cavity, which is different in volume. This type of pneumothorax occurs when the visceral pleura is damaged.

Clinical picture and diagnosis of closed pneumothorax. The presence of a small amount of air in the pleural cavity (5-15%) may not be accompanied by clinical symptoms. In typical cases, shortness of breath, cyanosis are noted. The chest wall on the side of the lesion lags behind in the act of breathing. Percussion over it is determined by tympanitis, with ascultation - weakening or absence of respiratory noises. Radiologically, an accumulation of air is found in the pleural cavity, which usually looks like a layer of gas between the chest wall and the collapsed lung. The cause of a closed pneumothorax is clarified during thoracoscopy.

Treatment of closed pneumothorax. Held medical measures in patients with closed pneumothorax, they are aimed at removing air from the pleural cavity and straightening the lung. To do this, an emergency or thoracocentesis is performed in the II intercostal space along the midclavicular line with drainage according to Bulau, Redon. and if they are ineffective - thoracoscopic or thoracotomy with the elimination of the cause of pneumothorax. Pieumostasis is usually achieved by imposing a manual suture on the lung tissue, a special loop (Raeder), stitching with a light stapler. Less commonly, atypical (marginal) lung resection. At the same time, with significant pneumothorax, but not accompanied by respiratory failure, it is proposed not to drain the pleural cavity for several days, which is motivated by the creation of more optimal conditions for scarring the site of rupture of the visceral pleura with a collapsed lung (Petersen, 1996).

Valvular and tension pneumothorax

Valvular pneumothorax is a progressive accumulation of air in the pleural cavity. With tension pneumothorax, as a result of a progressive increase in intrapleural pressure, the lung collapses on the side of the lesion, the mediastinum is displaced with compression of the opposite lung. Valvular and tension pneumothorax develops with any type of injury to the parietal and visceral pleura. It occurs only when, due to the collapse of the walls of the wound channel in the form of a valve, air passes through tissue defects in only one direction - into the pleural cavity.

Clinical picture and diagnosis. In patients, respiratory and heart failure is rapidly increasing: severe shortness of breath, cyanosis, fear, tachycardia, hypotension. objective examination data instrumental examination the same as in closed pneumothorax, but in patients with tension pneumothorax, there is a significant shift of the mediastinum to the healthy side and the collapsing of the opposite lung.

Treatment of tension pneumothorax. First aid to the victims consists in transferring valvular and tension pneumothorax into an open one by puncturing the pleural cavity with a thin needle; thoracocentesis with drainage of the pleural cavity according to Bulau. If it is impossible to permanently expand the lung with conservative measures, it is indicated surgery, the volume of which depends on the underlying cause of the disease.

Spontaneous pneumothorax

Spontaneous pneumothorax occurs without the influence of any producing factors.

Prevalence. Spontaneous pneumothorax occurs at any age. More often it is observed in men (80%). In 2 - 3% of patients in the course of life, spontaneous pneumothorax develops on both sides. In 30 - 50% of cases, this type of pneumothorax recurs.

Etiology and pathogenesis. In 88-92% of cases, the cause of spontaneous pneumothorax is bullous emphysema. Its development is associated with: 1) valve obstruction of the bronchioles, which gradually leads to an increase in the size of the alveoli, their atrophy, followed by rupture of the interalveolar septa; 2) with a genetically determined or acquired disorder in the protease-antiprotease system with a predominance of the processes of catabolism of the lung tissue; 3) with lung ischemia; 4) with pneumosclerosis.

In 8-12% of patients, spontaneous pneumothorax complicates the course of subpleural lung cyst and acute pneumonia. It is rarely seen in pulmonary tuberculosis in the decay phase lung cancer. Sometimes the cause of a spontaneous pneumothorax cannot be determined (idiopathic spontaneous pneumothorax).

Symptoms of spontaneous pneumothorax. Manifestations of spontaneous pneumothorax are diverse - from asymptomatic to severe pulmonary-cardiac disorders with a valve mechanism for air to enter the pleural cavity.

Diagnostics. The leading role in the diagnosis of spontaneous pneumothorax is given to x-ray examination, bronchoscopy, bronchography, CT, .

Treatment of spontaneous pneumothorax. In most patients with spontaneous pneumothorax, expansion of the lung is achieved using minor surgery methods - drainage of the pleural cavity with passive or active aspiration. Usually, a drainage tube is passed into the pleural cavity transthoracically in the II-III intercostal space along the midclavicular line. For the prevention of relapse, chemical (drug) obliteration of the pleural cavity (pleurodesis) is used by introducing talc, tetracycline, vibromycin, etc. into it through a transthoracic or thoracoscope. For the same purpose, endoscopic thermal (quantum) pleurodesis and lung irradiation with low-frequency ultrasound, electroscarification of the parietal pleura are used. Surgery is indicated in case of failure conservative treatment, in the presence of a widespread lesion of the lung. Videothoracoscopy or thoracotomy is performed with elimination of the cause of spontaneous pneumothorax and obliteration of the pleural cavity. During surgery, multiple small and single large (more than 2 cm in diameter) bullae are removed by atypical (marginal) resection using endostaplers (video thoracoscopy) or laser coagulation. With bullae less than 2 cm in diameter, their electrocoagulation is performed. To achieve obliteration of the pleural cavity, a pleurectomy (from II to VII intercostal space) or pleurodesis is performed.

The article was prepared and edited by: surgeon

Closed pneumothorax is a partial or complete collapse of the lung as a result of air entering the pleural cavity, but not from the external environment through a defect in the chest wall, but from the inside through damaged lungs and bronchi. This most often occurs with closed chest injuries or destructive pathologies of the lungs. This condition requires urgent medical attention, as it can lead to severe respiratory failure and death.

Pneumothorax develops when air enters the pleural cavity. If this happens due to the resulting communication of the cavity with the environment, they speak of an open pneumothorax.

There are small (limited), medium and total pneumothorax, depending on the degree of collapse and exclusion of the organ from breathing.

What causes such a pathology

These pathologies include:

bronchiectasis;
chronic obstructive bronchitis;
tuberculosis;
bullous emphysema;
pneumosclerosis;
cystic fibrosis;
tumor processes;
malformations, etc.

Also, closed pneumothorax can occur as a complication of medical manipulations, in particular, artificial lung ventilation, surgical interventions in this area.

Development mechanism

In the case of valvular pneumothorax, air enters the pleural cavity with each breath, but does not exit back. The pressure increases and the lung is compressed and collapses more and more.

This pathology requires emergency medical care, as it can quickly lead to severe respiratory failure incompatible with life.

Clinical picture

Symptoms of pathology depend on the volume of air that has entered the pleural cavity.

Table 1. Stages of pneumothorax:

With average and total pneumothorax, the clinical picture develops suddenly and begins with the appearance of sharp pains in the chest, which can radiate to the neck or arm. In parallel, the patient has a feeling of lack of air and shortness of breath.

Since blood circulation is disturbed in the affected lung, due to which oxygen enrichment of the blood suffers, the blood pressure in patients drops and the pulse quickens. Outwardly, pallor of the skin and acrocyanosis (blue nose, lips, fingertips) attract attention. When air enters the subcutaneous fatty tissue, subcutaneous emphysema can be seen.

Diagnostics

Characteristic clinical symptoms make it possible to suspect pneumothorax at the stage of questioning and examining the patient. On auscultation of the lungs, the doctor hears weakened breathing from the side of the lesion, and on percussion - a boxed sound. Palpation allows you to determine the lagging of one side of the chest during breathing, and if subcutaneous emphysema occurs, to identify a characteristic crunch.

Confirm the diagnosis with x-rays. When conducting this study, the mediastinum is displaced to one side and the accumulation of gas in the pleural cavity. What a pneumothorax looks like on an x-ray is shown in the photo below.

In difficult cases, pleural puncture and thoracoscopy are used to clarify the diagnosis. You can learn more about the diagnosis of closed pneumothorax from the video in this article.

Treatment

In all other cases, emergency medical intervention is necessary.

Attention! If a pneumothorax is suspected, an ambulance should be called as soon as possible. This can be done by calling 103, 112 (a single number for calling all emergency services), 911 (the number of the rescue service in the United States, but dialing it anywhere in the world triggers a connection to the nearest police station or rescue service).

While waiting for the ambulance, the patient needs to be reassured, helped to take a comfortable position, provide fresh air (open windows).

hospital therapy

In order to relieve the patient's symptoms, the doctor will prescribe antitussive and pain medications. Oxygen therapy is used to reduce respiratory failure. In case of marked cardiovascular insufficiency, appropriate treatment is carried out after consultation with a cardiologist.

Open surgery (thoracotomy) is the last resort for closed pneumothorax. It is resorted to if there are no other options left, when hours or minutes count, and the cost of delay may be equal to death.

Forecast and prevention

The prognosis for closed pneumothorax is generally favorable. With timely diagnosis and treatment, it is possible to remove all the air from the pleural cavity and stop all symptoms. Relapses of this disease are almost never found. The exception is chronic lung diseases with destructive disorders.

There is no specific prevention of pneumothorax. You should try to avoid traumatic sports and recreation, treat lung diseases in time, and stop smoking.

Closed pneumothorax is an acute pathology requiring immediate medical attention. You can't try to fix it on your own. The main task of the relatives of patients in this case is to deliver the patient to the hospital as soon as possible. The best way to do this is with a specialized ambulance.