Pneumothorax: what is it? Causes, symptoms and treatment of pneumothorax. Closed pneumothorax Video: pneumothorax, medical animation

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 lung pathologies. 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 occurs due to the formed communication of the cavity with the environment, they speak of an open pneumothorax.

In the case of closed pathology, there is no such communication; air enters the pleural space from the lungs. At the same time, pressure increases in the pleural cavity, 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 pneumothorax. However, if total collapse or bilateral damage occurs, this disease threatens the rapid development of respiratory failure, which can lead to death.

What causes this pathology

Most often, chest injuries (for example, rib fractures leading to lung rupture) and diseases accompanied by destruction of lung tissue lead to the development of pathology.

Such pathologies include:

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

All these diseases can lead to secondary pneumothorax. But sometimes this disease develops primarily, 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 procedures, in particular, artificial ventilation of the lungs, surgical interventions in this area.

Development mechanism

Normally, the pressure in the pleural cavity is negative. This promotes full expansion of the lungs. When the integrity of the pleura is violated and air enters the cavity, the pressure begins to increase, which leads to the collapse of the lung to one degree or another.

With classic 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 heals. If the volume of gas that has penetrated into the cavity is small, it gradually resolves and the lung expands. Such conditions most often do not require any treatment.

In the event of a valvular pneumothorax, air enters the pleural cavity with each breath, but does not escape 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 trapped in the pleural cavity.

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

Table 1. Stages of pneumothorax:

With moderate and total pneumothorax, the clinical picture develops suddenly and begins with the appearance of sharp pain in the chest, which can radiate to the neck or arm. At the same time, the patient experiences a feeling of lack of air and shortness of breath.

Since blood circulation is disrupted in the affected lung, causing oxygen enrichment in the blood to suffer, the patient’s blood pressure drops and the pulse quickens. Externally, pallor of the skin and acrocyanosis (blue discoloration of the nose, lips, fingertips) attract attention. When air gets into the subcutaneous fatty tissue, subcutaneous emphysema can be noticed.

With valvular pneumothorax, all symptoms quickly increase. The patient is in a forced position in order to facilitate breathing, greedily gasps for air, and often experiences panic states 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 one to suspect pneumothorax even at the stage of interviewing and examining the patient. When auscultating the lungs, the doctor hears weakened breathing from the affected side, and during percussion - a box sound. Palpation allows you to determine the lag of one side of the chest when breathing, and if subcutaneous emphysema occurs, identify a characteristic crunch.

The diagnosis is confirmed by radiography. When conducting this study, a shift of the mediastinum to one side and accumulation of gas in the pleural cavity are visible. 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 diagnosing 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 disorder is detected during 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 you suspect pneumothorax, you should call an ambulance as soon as possible. This can be done by calling 103, 112 (a single number for calling all emergency services), 911 (a rescue number in the USA, but dialing it anywhere in the world will connect you to the nearest police department or rescue service).

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

Hospital therapy

An ambulance will hospitalize the victim in the surgery or pulmonology department. There he will be able to be provided with complete rest and qualified treatment. With minor disturbances and a small amount of air in the pleura, if there is no new entry of air, treatment can be conservative.

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

To eliminate air from the pleural cavity, pleural puncture is used - puncture of the pleura with a long needle and tube. As a result of the release of all accumulated gas, negative pressure will be restored in the pleural cavity, which will allow the lung to expand and regain its functionality. Such measures will help relieve all 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, 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 the source of air entering the pleural cavity. To do this, they resort to thoracoscopy, with the help of which they find and eliminate the pleural defect.

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

Prognosis and prevention

The prognosis for closed pneumothorax is generally favorable. With timely diagnosis and treatment, it is possible to remove all air from the pleural cavity and relieve all symptoms. Relapses of this disease practically do not occur. The exception is chronic lung diseases with destructive disorders.

There is no specific prevention for pneumothorax. You need to try to avoid traumatic sports and recreation, treat lung diseases in a timely manner, and stop smoking.

In some cases (with superficial location of bullae and bronchiectasis), the instructions recommend preventive operations to remove affected areas of lung tissue adjacent to the pleura.

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

• Sudden pain in the chest - acute, intensifying during inspiration; may radiate to the shoulder of the affected side.
• Sudden shortness of breath - difficulty breathing, rapid shallow breathing.
• A dry cough is possible.
• Increased heart rate.
• Cold, sticky sweat appears on the skin.
• General weakness.
• Feeling of fear.
• In case of severe respiratory and circulatory disorders - cyanosis of the skin.
• With an open pneumothorax (the presence of a chest wound through which the pleural cavity communicates with the external environment), during inhalation through the wound air is sucked in with a whistle; during exhalation, air comes out through the wound, “foaming” the blood released from the wound.

Forms

• Closed pneumothorax– develops in cases where air enters the pleural cavity through a pleural defect, but the defect is small and quickly closes. There is no communication between the pleural cavity and the environment, and the volume of air entering the pleural cavity does not increase. Clinically, it has the mildest course: a small amount of air can resolve on its own.
• Open pneumothorax- an accumulation of air in the pleural cavity that communicates with the environment through a wound in the chest wall or through a damaged large bronchus. When you inhale, air enters the pleural cavity, and when you exhale, it comes out back. The pressure in the pleural cavity becomes equal to atmospheric pressure, which leads to the collapse of the lung and its exclusion from breathing.
• Valve (tension) pneumothorax- the most difficult option. If the wound is large and a medium-sized bronchus is damaged, a valve structure is formed that allows air into the pleural cavity at the time of inhalation and prevents it from escaping into the environment during exhalation, while the volume of air in the pleural cavity gradually increases. This leads to displacement and compression of the mediastinal organs (heart, large vessels) with significant respiratory and circulatory disorders.

Causes

Based on the causes of occurrence, the following types of pneumothorax are distinguished.

• Spontaneous (spontaneous) pneumothorax– rupture of a bronchus or part of the lung, not associated with mechanical damage to the lungs or chest.
  • Primary(idiopathic) – occurs for no apparent reason. It is more common in young, tall men aged 20-40 years. As a rule, it is based on:
    • genetically determined deficiency of the enzyme alpha-1-antitrypsin, which leads to pathological changes in the lungs;
    • congenital weakness of the pleura, which easily ruptures with strong coughing, laughter, deep breathing, intense physical effort;
    • It is possible to develop spontaneous pneumothorax during deep immersion in water, diving, or flying in an airplane at high altitude (associated with pressure changes).
  • Secondary(symptomatic) – against the background of existing pulmonary pathology:
    • diseases of the respiratory tract, for example, chronic obstructive pulmonary disease (COPD is a chronic inflammatory disease of the respiratory system that occurs under the influence of various environmental factors, the main one of which is smoking, leading to the development of chronic respiratory failure), cystic fibrosis (a hereditary disease characterized by dysfunction of the glands of the external secretions, including bronchial secretions, which leads to the appearance of viscous, thick sputum), severe exacerbation of bronchial asthma;
    • infectious diseases of the lungs: for example, tuberculosis (an infectious disease caused by Mycobacterium tuberculosis), lung abscess (a limited focus of inflammation of the lung tissue with its melting and the formation of a cavity filled with purulent masses), pneumonia (pneumonia) due to HIV infection;
    • lung diseases that affect connective tissue: fibrosing alveolitis, lymphangioleiomyomatosis, sarcoidosis, histiocytosis X;
    • systemic connective tissue diseases affecting the lungs (systemic scleroderma, rheumatoid arthritis, dermatomyositis);
    • tumors (lung cancer).
• Traumatic pneumothorax – for chest injuries:
  • penetrating chest injury;
  • blunt chest trauma.
• Iatrogenic pneumothorax, associated with medical procedures:
  • during a biopsy (taking a small area for examination) of the lungs or pleura;
  • during puncture (puncture of the pleural cavity for the purpose of pumping out pathological contents);
  • when placing a subclavian catheter;
  • during artificial ventilation (barotrauma).

Diagnostics

• General examination (examination of the chest, listening to the lungs using a phonendoscope).
• X-ray of the chest organs, which allows you to detect air in the pleural cavity (the cavity formed by the layers of the pleura - the outer layer of the lungs). It is the main method for diagnosing pneumothorax.
• Computed tomography – to identify the causes of secondary spontaneous pneumothorax and if radiography is insufficiently informative.
• Study of blood gas composition. The method is auxiliary.
• Electrocardiography (ECG) - allows you to detect changes in the functioning of the heart during tension (valve) pneumothorax. The method is auxiliary.
• A consultation with a thoracic surgeon is also possible.

Treatment of pneumothorax

• If there is a small amount of air in the pleural cavity that does not interfere with the breathing mechanism, it can resolve on its own and does not require treatment.
• Pleural puncture with suction of air from the pleural cavity (the cavity formed by the layers of the pleura - the outer lining of the lungs).
• Drainage of the pleural cavity with the installation of a drainage tube through which air will be removed from the pleural cavity.
• Surgical suturing of ruptured lungs, bronchi, and chest wall wounds.
• Painkillers (for severe pain).
• Oxygen therapy (long-term oxygen supply through special tube systems).
• Pleurodesis is the fusion of the pleura with the help of special drugs injected into the pleural cavity or surgically (for frequently recurring pneumothorax).

Complications and consequences

• Intrapleural bleeding.
• Pleurisy is inflammation of the pleura with the possible formation of adhesions leading to impaired expansion of the lung.
• Subcutaneous emphysema - release of air into the subcutaneous fat. It is defined as areas of swelling, swelling of the subcutaneous tissue, when pressed, a sound resembling the crunch of dry snow occurs.
• Penetration of air into the mediastinal tissue with compression of the heart and large vessels.
• In severe cases (large volume of damage, significant penetrating injury to the chest), death is possible.

Prevention of pneumothorax

• Timely treatment of lung diseases.
• To give up smoking.
• Avoiding chest injuries.
• Prevention of repeated pneumothoraxes (if they are repeated frequently) - pleurodesis (fusion of the pleura with the help of special drugs injected into the pleural cavity or surgically).

Pneumothorax is the presence of air between the chest wall and the lung in the pleural cavity, which occurs as a result of a wound to the chest wall or lung with disruption of one of the branches of the bronchus.

Typically, pneumothorax occurs in patients aged 20 to 40 years. If the flow of air into the pleural cavity has stopped, the pneumothorax is considered closed.

With an open pneumothorax, air flows freely into it and, when exhaled, moves in the opposite direction. With valvular pneumothorax, air during inspiration penetrates into the pleural cavity, but has no exit from it.

Pneumothorax can be unilateral or bilateral, depending on the degree of lung collapse, complete or partial. According to etiology, spontaneous, traumatic (including surgical) and artificial pneumothorax are distinguished.

Causes of pneumothorax

Causes of pneumothorax:

• closed or open chest injury;
• penetrating wounds;
• lung damage from pieces of ribs;
• complication after therapeutic or diagnostic intervention;
• spontaneous pneumothorax;
• tuberculous pneumothorax;
• nonspecific pneumothorax;
• cavity rupture, breakthroughs of caseous foci.

Types of pneumothorax

Closed pneumothorax

Closed pneumothorax occurs when a non-increasing amount of gas enters the pleural cavity. Closed pneumothorax is the easiest type of pneumothorax, since the air itself can gradually dissolve from the pleural cavity, and the lung can expand.

Open pneumothorax

Open pneumothorax is determined by the presence of an opening in the chest, which freely communicates with the external environment, as a result of which the pressure in the pleural cavity is equal to atmospheric pressure. In this case, the lung collapses, is switched off from the breathing process, gas exchange does not occur in it and oxygen enters the blood in a smaller volume.

Valvular or tension pneumothorax

Valvular or tension pneumothorax is an increasing accumulation of air in the pleural cavity, which occurs when a valve is formed that allows air only into the pleural cavity and prevents it from exiting back. When you inhale, air enters the lung, and when you exhale, finding no outlet, it remains in the pleural cavity.

Typical signs of valvular pneumothorax: positive intrapleural pressure, which leads to the exclusion of the lung from breathing, the addition of irritation of the nerve endings of the pleura, leading to pleuropulmonary shock; persistent displacement of the mediastinal organs, which disrupts their function by squeezing large vessels; acute respiratory failure.

Partial and complete pneumothorax

Depending on the level of collapse of the lung and the volume of air in the pleural cavity, partial and complete pneumothorax are distinguished. Complete bilateral pneumothorax in the absence of prompt assistance to the victim leads to death due to complete respiratory failure.

Symptoms of pneumothorax

The symptoms of pneumothorax depend on the causes of its occurrence, the mechanism of the disease and the degree of collapse of the lung. Pneumothorax occurs acutely, after physical exertion, and is manifested by the following symptoms:

The patient breathes shallowly and frequently and feels a “lack of air” and has severe shortness of breath. Pallor or blue discoloration of the skin of the body and face appears. With an open pneumothorax, the patient lies on the side of the injury, tightly pressing the wound. When examining the wound, you can hear the sound of air; blood and foam may be released from it. The movements of the patient's chest are asymmetrical.

Complications of pneumothorax

Complications of pneumothorax occur frequently, according to statistics - half of all cases. These include:

With valvular pneumothorax, the formation of subcutaneous emphysema is possible - the accumulation of a small amount of air under the skin in the subcutaneous fat.

First aid for pneumothorax

If you suspect a pneumothorax, you must immediately call an ambulance or consult a doctor, especially if it is a valve pneumothorax, which, if not provided, can lead to death.

If the patient has an open pneumothorax, you need to apply a sealed bandage to the open chest wound. It can be made from oilcloth material, plastic film or a thick gauze-cotton bandage.

Treatment of pneumothorax

Treatment of pneumothorax includes the following measures:

The course of closed pneumothorax is benign, but in some cases a pleural puncture is necessary to suction air.

With an open pneumothorax, you first need to convert it to a closed one, eliminating communication with the external environment by sealing the wound. If valvular pneumothorax is present, surgical intervention is necessary.

Questions and answers on the topic "Pneumothorax"

Question:Hello! He suffered 2 pneumothoraxes with an interval of 7 years, on the left and on the right lung. The last one, the left one, was in 2005. I refused the operation - I feel good, I smoke (I quit), and I don’t deny myself physical activity. A week ago, while driving a go-kart (a small sports car), I received a strong blow to the left chest from the side protrusion of the seat during a collision. At the moment of the impact there was severe shortness of breath, but it went away almost immediately. Basically I have no complaints, a couple of times after this incident the adhesions “twitched”. I would like to know to what extent this injury will provoke a relapse of SP, because... Are there bullae on the lungs?

Answer: If this injury is not caused by a rib fracture, then there is no additional risk for the development of pneumothorax. The chest is a fairly elastic and mechanically strong structure, and the lung, even with bullae, is not so vulnerable. to burst with every blow. A more significant threat is “straining” - in particular, you can imagine a musician playing the trumpet or a person pumping a volleyball with his mouth. To be sure of the condition of the lung, it makes sense to do a computed tomography scan.

Question:After a postoperative operation for pneumothorax, I felt much better, but I would like to know whether it is possible to identify or minimize its occurrence, since I really want to work in the police and because I am a conscript, and the very fact that I am incapacitated and I can’t pay off my debt, it leads me to complexes, which is completely unnecessary for me. If there are methods, then please give me the opportunity to learn about them. Thank you in advance.

Answer: All treatment of pneumothorax consists of methods of its prevention. If you were operated on, then they probably removed part of the lung with bullae and performed one or another version of pleurodesis. The only way you can help yourself is to stop smoking if you smoke. Otherwise, you can consider yourself an absolutely healthy person.

Question:Hello. I had a spontaneous pneumothorax. I was told that it was associated with a large weight loss (from 53 to 40 kg) and I was also diagnosed with bronchial asthma since childhood. 5 years have already passed and now I want to go on vacation with my son; it takes 4 hours to fly by plane. Please tell me can I fly or not?

Answer: You can fly on a passenger plane; the flight does not increase the risk of developing pneumothorax. You cannot fly with an unresolved pneumothorax.

Question:Good afternoon I had three pneumothoraxes in January, April and July of this year. CT and videothoroscopic examination did not reveal any abnormalities. During treatment for the third time, doctors induced pleurodesis with talc (as written in the extract). Is it possible for pneumothorax to reoccur and do I need to have surgery?

Answer: Talc pleurodesis is one of the treatment options for pneumothorax. Let's hope the pneumothorax doesn't happen again.

Question:Which sanatoriums specialize in the treatment of pneumothorax. My friend had this happen twice already on the same side. What methods of prevention exist? Thanks a lot.

Question:Hello. A year ago, my husband’s lung burst in the gym, and he was diagnosed with pneumothorax of the right lung. A year later, the pain returned. Please tell me what to do, what medications to take?

Answer: If pneumothorax was repeated 2 times (unfortunately, we can talk about recurrent spontaneous pneumothorax), then it will repeat for the third and fourth time. In such cases, surgery is indicated to prevent relapses.

General information

(Greek pnéuma - air, thorax - chest) - accumulation of gas in the pleural cavity, leading to collapse of lung tissue, displacement of the mediastinum to the healthy side, compression of the blood vessels of the mediastinum, lowering of the dome of the diaphragm, which ultimately causes respiratory dysfunction and blood circulation In pneumothorax, air can penetrate between the layers of the visceral and parietal pleura through any defect on the surface of the lung or in the chest. Air penetrating into the pleural cavity causes an increase in intrapleural pressure (normally it is lower than atmospheric pressure) and leads to the collapse of part or the whole lung (partial or complete collapse of the lung).

Causes of pneumothorax

The mechanism of development of pneumothorax is based on two groups of reasons:

Pneumothorax Clinic

The severity of pneumothorax symptoms depends on the cause of the disease and the degree of compression of the lung.

A patient with an open pneumothorax takes a forced position, lying on the injured side and tightly pressing the wound. Air is sucked into the wound with noise, foamy blood mixed with air is released from the wound, the excursion of the chest is asymmetrical (the affected side lags behind when breathing).

The development of spontaneous pneumothorax is usually acute: after a coughing attack, physical effort, or without any apparent reason. With the typical onset of pneumothorax, a piercing stabbing pain appears on the side of the affected lung, radiating to the arm, neck, and behind the sternum. The pain intensifies with coughing, breathing, and the slightest movement. Often pain causes the patient to have a panicky fear of death. Pain syndrome in pneumothorax is accompanied by shortness of breath, the severity of which depends on the volume of collapse of the lung (from rapid breathing to severe respiratory failure). Pallor or cyanosis of the face appears, and sometimes a dry cough.

After a few hours, the intensity of the pain and shortness of breath weaken: the pain bothers you at the moment of taking a deep breath, shortness of breath manifests itself with physical effort. The development of subcutaneous or mediastinal emphysema is possible - the release of air into the subcutaneous tissue of the face, neck, chest or mediastinum, accompanied by swelling and a characteristic crunch upon palpation. On auscultation on the side of the pneumothorax, breathing is weakened or not heard.

In approximately a quarter of cases, spontaneous pneumothorax has an atypical onset and develops gradually. Pain and shortness of breath are minor, and as the patient adapts to new breathing conditions, they become almost unnoticeable. An atypical form of the course is characteristic of limited pneumothorax, with a small amount of air in the pleural cavity.

Clearly clinical signs of pneumothorax are determined when the lung collapses by more than 30-40%. 4-6 hours after the development of spontaneous pneumothorax, an inflammatory reaction from the pleura occurs. After a few days, the pleural layers thicken due to fibrin deposits and edema, which subsequently leads to the formation of pleural adhesions, making it difficult to straighten the lung tissue.

Complications of pneumothorax

Complicated pneumothorax occurs in 50% of patients. The most common complications of pneumothorax are:

• hemopneumothorax (when blood enters the pleural cavity)
• pleural empyema (pyopneumothorax)
• rigid lung (not expanding as a result of the formation of connective tissue cords)
• acute respiratory failure

With spontaneous and especially valvular pneumothorax, subcutaneous and mediastinal emphysema can be observed. Spontaneous pneumothorax occurs with relapses in almost half of patients.

Diagnosis of pneumothorax

Already upon examination of the patient, characteristic signs of pneumothorax are revealed:

• the patient takes a forced sitting or semi-sitting position;
• the skin is covered with cold sweat, shortness of breath, cyanosis;
• expansion of the intercostal spaces and chest, limitation of chest excursion on the affected side;
• decreased blood pressure, tachycardia, displacement of the boundaries of the heart in a healthy direction.

Specific laboratory changes for pneumothorax are not determined. Final confirmation of the diagnosis occurs after an X-ray examination. When radiography of the lungs, on the side of the pneumothorax, a zone of clearing is determined, devoid of a pulmonary pattern on the periphery and separated by a clear boundary from the collapsed lung; displacement of the mediastinal organs to the healthy side, and the dome of the diaphragm downwards. During diagnostic pleural puncture, air is obtained, the pressure in the pleural cavity fluctuates within zero.

Treatment of pneumothorax

First aid

Pneumothorax is a medical emergency that requires immediate medical attention. Any person should be ready to provide emergency assistance to a patient with pneumothorax: calm him down, ensure sufficient oxygen access, and immediately call a doctor.

For open pneumothorax, first aid consists of applying an occlusive dressing to hermetically seal the defect in the chest wall. An airtight bandage can be made from cellophane or polyethylene, as well as a thick cotton-gauze layer. In the presence of valvular pneumothorax, an urgent pleural puncture is necessary to remove free gas, straighten the lung and eliminate displacement of the mediastinal organs.

Qualified help

Patients with pneumothorax are hospitalized in a surgical hospital (if possible, in specialized pulmonology departments). Medical care for pneumothorax consists of performing a puncture of the pleural cavity, evacuating air and restoring negative pressure in the pleural cavity.

In case of closed pneumothorax, air is aspirated through a puncture system (a long needle with an attached tube) in a small operating room, observing asepsis. Pleural puncture for pneumothorax is performed on the injured side in the second intercostal space along the midclavicular line, along the upper edge of the inferior rib. In case of total pneumothorax, in order to avoid rapid expansion of the lung and the patient's shock reaction, as well as in case of defects in the lung tissue, drainage is installed in the pleural cavity, followed by passive aspiration of air according to Bulau, or active aspiration using an electric vacuum device.

Treatment of open pneumothorax begins with its transfer to a closed one by suturing the defect and stopping the flow of air into the pleural cavity. In the future, the same measures are carried out as for closed pneumothorax. In order to reduce intrapleural pressure, valve pneumothorax is first converted into open pneumothorax by puncture with a thick needle, then surgically treated.

An important component of the treatment of pneumothorax is adequate pain relief both during the period of collapse of the lung and during its expansion. In order to prevent recurrence of pneumothorax, pleurodesis is performed with talc, silver nitrate, glucose solution or other sclerosing drugs, artificially causing an adhesive process in the pleural cavity. For recurrent spontaneous pneumothorax caused by bullous emphysema, surgical treatment (removal of air cysts) is indicated.

Forecast and prevention of pneumothorax

In uncomplicated forms of spontaneous pneumothorax, the outcome is favorable, however, frequent relapses of the disease are possible in the presence of lung pathology.

There are no specific methods for preventing pneumothorax. It is recommended to carry out timely therapeutic and diagnostic measures for lung diseases. Patients who have had pneumothorax are advised to avoid physical activity and be examined for COPD and tuberculosis. Prevention of recurrent pneumothorax consists of surgical removal of the source of the disease.

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 pneumothorax occur after chest trauma or as a complication of treatment. Causes: closed chest injury with rupture of lung tissue, penetrating wound with rapid adhesion of the chest wall wound and continued gaping of the bronchial wound. Closed pneumothorax is a complication of chest injury and is an indisputable sign of rupture of the lung or (less often) bronchus. May occur simultaneously with subcutaneous emphysema. Lung rupture occurs as a result of direct injury from fragments of a broken rib or (less often) sharp tension of the lungs in the root area at the moment of hitting 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 sharp pain in the chest, breathes quickly and shallowly, with shortness of breath. Feels “short of air.” Pallor or cyanosis of the skin, in particular the face, appears. Auscultation of breathing on the side of the injury is sharply weakened, percussion - a sound with a boxy tint. Subcutaneous emphysema may be detected.

First aid. At the scene: pain relief, cardiovascular medications, semi-sitting position. During transportation: 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 flows through the needle into the syringe under pressure in 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 glove finger. The tube is lowered into a bottle with furatsilin. With a tension pneumothorax, air bubbles are visible, released from the tube and passing through the furacilin. The end of the needle protruding above the skin of the chest wall is wrapped with an adhesive plaster and it is also attached to the chest wall.

Qualified help Treatment of pneumothorax consists of its elimination by suctioning air from the pleural cavity and restoring negative pressure in it. For closed pneumothorax without an active connection to the lung, puncture aspiration of gas from the pleural cavity using a kit for eliminating pneumothorax in aseptic operating room conditions is sufficient. If needle aspiration is ineffective, this indicates the entry of air from the lung tissue. In such cases, sealed drainage of the pleural cavity is performed (“Bulau drainage”), or an active aspiration system is created, including the use of electric vacuum devices.

Task 1 Method of treating a fracture - HELL KNOWS THIS OLD FART. Treatment. Anesthesia, reposition, mobilization, osteosynthesis.

Task 2. Crash syndrome. X-ray. Treatment: urgent hospitalization, cold. Next, pain is relieved through blockades. To improve microcirculation, combat shock and acute renal failure, infusion therapy is performed. To detoxify and improve microcirculation, glucose 5% and HES are administered. Antiarrhythmics, analgesics, and diuretics are used as symptomatic therapy. Surgical treatment methods include fasciotomy.

Ticket 3 1.Classification of fractures.

FRACTURE (fractura) called a violation of bone integrity.

1. CLASSIFICATION

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

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

Traumatic fractures occur in an initially intact bone.

Pathological fractures occur when exposed to significantly less force (sometimes when turning in bed, leaning on a table, etc.).

2. According to the presence of damage to the skin Fractures are divided into open and closed.

A special group consists of gunshot fractures. Their feature is massive damage to bones and soft tissues. Arteries, veins, and nerves are often damaged.

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

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

Incomplete fractures include cracks, subperiosteal fractures in children of the “green” type twigs".

4. According to the direction of the line Fractures include transverse, oblique, longitudinal, comminuted, helical, impacted, compression and avulsion fractures.

In this case, each type of fracture usually corresponds to a specific mechanism of injury. a helical fracture occurs when a limb twists, rotates, and the proximal or distal part is immobilized. An avulsion fracture occurs when a particular muscle group is overly contracted or stressed.

Compression - with powerful impact along the axis.

5. Depending on the presence of displacement( dislocation ) Fractures of bone fragments relative to each other can be without displacement and with displacement.

Displacement of bone fragments can be:

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. Difficulty Injuries to the musculoskeletal system include simple and complex fractures.

Simple fractures are those in which the integrity of only one bone is broken.

9. Depending on the development of complications There are uncomplicated and complicated fractures.

Possible complications of fractures:

Traumatic shock

Damage to internal organs

Damage to blood vessels

Fat embolism,

Wound infection, osteomyelitis, sepsis.

10. In the presence of a combination of fractures with injuries of a different nature they speak of combined trauma or polytrauma. Examples of combined injuries:

Fractures of the shin bones on both limbs and rupture of the spleen;

Shoulder fracture, hip dislocation and brain contusion.