Open pneumothorax

Introduction to open pneumothorax The open pneumothorax refers to the pneumothorax that causes the pneumothorax to be continuously open, and the gas enters and exits the pleural cavity with the breath. Causes of open pneumothorax is chest trauma, common in car accidents, gunshot wounds, explosive skin injury caused by chest wall defects, pleural cavity and external communication, so that air through the chest wound, lung, trachea and esophageal rupture or soft tissue defect, with breathing Free access to the pleural cavity, causing normal negative pressure to disappear. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: septic shock, blood pneumothorax, pleural effusion

Open pneumothorax

Chest trauma (40%):

Causes of open pneumothorax is chest trauma, common in car accidents, gunshot wounds, explosive skin injury caused by chest wall defects, pleural cavity and external communication, so that air through the chest wound, lung, trachea and esophageal rupture or soft tissue defect, with breathing Free access to the pleural cavity, causing normal negative pressure to disappear.

Ventilation disorders (20%):

The injured side of the lung can completely collapse, the mediastinum moves to the contralateral side, oppresses the healthy lung, the ventilation is insufficient, the blood in the collapsed alveolar region can not be oxygenated, the pulmonary artery and venous shunt increase, causing systemic hypoxia and carbon dioxide accumulation, inhalation injury Some residual gas in the lateral lung is inhaled into the healthy lung. When exhaling, the residual lung part of the healthy side enters the affected side of the lung, which is called mediastinal flutter, which aggravates hypoxia and carbon dioxide retention.

Circulatory disorders (20%):

The disappearance of negative pressure in the pleural cavity affects venous return, and the mediastinal flutter causes the gap between the vena cava and the right atrium to be twisted, which can further reduce the amount of blood returning to the heart and cause circulatory disorders.

Open pneumothorax prevention

Pay attention to traffic safety, avoid falling and stab wounds, pay attention to strict surgical indications during medical treatment, and avoid iatrogenic pneumothorax.

Open pneumothorax complications Complications , septic shock, blood-thoracic pleural effusion

1. Pleural effusion: the incidence rate is 30% to 40%, more than 3 to 5 days after the onset of pneumothorax, the amount is usually not much, the effusion not only aggravates the lung collapse, but also the open pneumothorax for open pneumothorax .

2. Pneumothorax: Pneumothorax secondary to S. aureus, anaerobic or Gram-negative bacilli, or pulmonary abscess, or caseous pneumonia is easy to be combined with pus.

3. Blood pneumothorax: Pneumothorax causes tearing of blood vessels in the pleural adhesion zone. The severity of the condition is related to the size of the torn blood vessel. Small bleeding can be stopped automatically with the contraction of the blood vessels and the contraction of the endothelium; the large blood pneumothorax is a rapid onset, except for chest pain, chest tightness, and shortness of breath, as well as dizziness, palpitation, paleness, cool skin, and decreased blood pressure. Such as hemorrhagic shock signs, X-ray examination showed liquid and gas plane, thoracic puncture for whole blood.

4. Chronic pneumothorax: Some patients with pneumothorax due to the underlying lesions can not close the pleural rupture with compression; form bronchial pleural fistula and difficult to heal; bronchoconstriction or occlusion can make the lungs unable to re-inflate; visceral pleural thickening muscles make the lungs Can not fully re-expand, so that the pneumothorax lasted more than 3 months.

5. Mediastinal emphysema: more complicated by tension pneumothorax. When the gas volume is low, there is no obvious symptom; if the gas volume is high and the rapid occurrence occurs, the circulation-respiratory failure will occur, and the condition is extremely sinister. The physical examination shows that the cyanosis, jugular vein engorgement, heartbeat can not be paralyzed, and the heart sounding circle shrinks or disappears, often accompanied by Subcutaneous emphysema (local swelling, palpation with a sense of snow, auscultation with sputum pronunciation), X-ray chest showed a translucent band on both sides of the mediastinum with a line of shadows.

6. Respiratory failure: This is a common complication of the elderly pneumothorax secondary to COPD.

7. Circulatory failure: more complicated by tension pneumothorax.

8. Heart failure: more common in elderly pneumothorax patients with severe heart disease. Heart failure can be induced by hypoxemia, infection, increased oxygen consumption by respiratory exercise, and arrhythmia caused by pneumothorax.

Open pneumothorax symptoms common symptoms blood pressure drop irritability shock shock bun bronchial subcutaneous emphysema

The patient showed irritability, cyanosis, respiratory distress, sweating, blood pressure drop, subcutaneous emphysema, and even shock. There was an open wound in the chest wall. When breathing, you could hear the sound of air passing through the wound into and out of the pleural cavity. The common signs were the affected chest. Full, respiratory movements are weakened, the drum sound is percussed, the trachea moves to the healthy side, and the breath sounds are reduced or disappeared.

Open pneumothorax examination

Thoracic and abdominal puncture

If the patient's blood pneumothorax and peritoneal irritation sign are present at the same time, chest and abdominal puncture should be performed as soon as possible. Thoracic and abdominal puncture is a simple and reliable diagnostic method.

2. X-ray inspection

It is an important method for the diagnosis of pneumothorax, the condition of the lung and the presence or absence of pleural adhesions, pleural effusion and mediastinal shift. A light-transmitting band appears next to the mediastinum suggesting mediastinal emphysema. The transthoracic line has increased brightness and no lung texture. Sometimes the pneumothorax line is not obvious enough, it can exhale the patient's breath, the lung volume is reduced, and the density is increased. This is in contrast to the exposed air-transparent band, which is conducive to the discovery of pneumothorax. When a large number of pneumothorax is used, the lungs are retracted toward the hilum and the outer edge is curved or lobulated.

3. CT examination

In the blunt trauma of the chest, hemothorax and pneumothorax exist simultaneously, which is mainly caused by lung contusion and lung rupture caused by chest compression and rib fracture. The gas-liquid level across one or both sides of the chest is characteristic of it.

4.B-ultrasound

In the blunt trauma of the chest, it is more sensitive than the X-ray. Under the B-ultrasound, the "sliding" of the pleura can be seen, and the presence or absence of pleural effusion can also be found.

Open pneumothorax diagnosis

According to the patient's medical history, clinical manifestations, combined with X-ray, if necessary, assisted CT and B-ultrasound examination is not difficult to confirm the diagnosis. According to the obvious sucking chest wound in open pneumothorax, the gas emits a characteristic leaking sound through the wound, and the diagnosis is not difficult. If necessary, X-ray examination is feasible to further confirm the diagnosis. This disease is generally not confused with other diseases.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.