PNEUMOTORAXUL

definition :
Intrapleural air collection consecutive burglary visceral pleura .

Pathogenesis :
1. seemingly primitive – exclusion diagnosis of lung , forming and breaking of apical vesicles subpleurale
2 . secondary to underlying lung disease or trauma
It may be unilateral or bilateral .
Classification by pathogenic mechanism :
a) traumatic pneumothorax – intrapleural pressure < atmospheric pressure
Movement:
1 . penetrating chest wound – colaband intrapleural air enters the lung to equalize the two pressure – open pneumothorax
2 . After communication with the outside penetration chest off quickly and intrapleural pressure remains < than atmospheric pressure – closed pneumothorax
Causes:
– Puncturing the chest with a sharp object
– Medical maneuvers – thoracentesis , central venous catheter placement Percutaneous subclavian vein
– Crushing chest – bronchopleural communication created by a fractured rib
– Instrumental maneuvers or intraesofagiene bronchial ( air duct or tract perforation pneumothorax and pneumomediastinum occur consecutively )
– Positive pressure mechanical ventilation – barotrauma
b ) spontaneous pneumothorax
can occur in :
– Healthy people by barotrauma ( high altitidine flight or dive into water from height ) – simple pneumothorax
– People with lung disease ( emphysema , chronic bronchitis , asthma, tuberculosis, lung abscess , with broncho – pleural fistula , cavern that opens in pleura )
– Bronchopleural fistula – cause the formation of a valve mechanism progressive accumulation of intrapleural air which causes lung collapse and contralateral shift of the mediastinum , cardio -respiratory failure consecutive – hypertensive pneumothorax , smothering valve
c ) induced pneumothorax purpose :
– Therapeutic – by introducing large amounts of intrapleural air – pleural empyema treatment to prevent contact simfizarea the layers of the pleura
– Diagnosis – to facilitate thoracoscopic examination of the pleura or chest radiographic visualization of structures

Clinical picture :
– Sudden onset of chest pain unilaterally irradiated to shoulder , and sometimes throughout the thorax and abdomen , violent, accentuated by coughing and dyspnea accompanied by intense polipnee
– The physical exam – hemitorace relaxed , breathing building with widened intercostal spaces ,

tRIAD :
1 . hypersonority
2 . disappearance of vocal vibrations
3. disappearance of breath sounds
Laboratory picture :
1 . Thoracic Rx : – hipertransparenta hemitoracica (no drawing broncho -vascular ) with lung toward the hilum sometimes pushing contralateral mediastinal shift )
2 . pleural pressure gauge measuring the water
– Intrapleural pressure < atmospheric pressure – closed pneumothorax , intrapleural air is gradually absorbed
– Intrapleural pressure = atmospheric pressure
– Intrapleural pressure > atmospheric pressure – intrapleural air quantity increases progressively through the valve mechanism
Charts :
1. spontaneous regression
2 . dramatic evolution consecutive to acute respiratory failure or circulatory failure acute lung colabarii row compression on the mediastinum if suffocating pneumothorax
3 . delay reexpansionarii – tendency to chronicity
4 . associated pleural effusions ( hidropneumotorax – exuding serofibrinos aseptically piopneumotorax – an abscess or pleural effusion secondary , hemopneumothorax )
5 . recurrence

Treatment:
Objectives:
– Decrease pain and improve dyspnea – decompression lungs and analgesics
– Reexpansionarea lung
– Prevention of relapse
Treatment depends on the intensity of the clinical and functional disorders

1 . closed pneumothorax with benign
– Rested for 10 days
– Avoid physical exertion until after lung reexpansionarea
– Analgesics ( Algocalmin , Fortral , Mialgin , Morphine )
– Cough – Codeine
– If there is a tendency to hypertension – vasoactive – dopamine, dobutamine
– Reexpansionarea lungs – by bronchoscopy with suction exsuflatie decompressive dispensers, continuous suction drainage tube ( minimal thoracotomy with drainage and sifonaj Pezzer probe under water )
2 . open pneumothorax , with a tendency to chronicity
– Surgical treatment – thoracotomy with fistula excision and bullous area then close communication and pleural decortication
3 . pneumothorax and phenomena of asphyxia valve
– Emergency exsuflatie 20ml syringe needle with thick short bizou after local anesthesia with lidocaine or pneumothorax apparatus with trocar valve in space or space V ic ic II axillary line average
4 . primitive recurrent pneumothorax
– Pleurotomie and drainage Pezzer probe
– Thoracoscopic laser ablation of communication
– Simfizarea pleura pleural injection of irritant agents : tetracyclines, sodium nitrate , Doxycycline , Minocycline

Reexpansionarea lungs :
– Spontaneous fistula closure by progressive resorption air and pleura
– Active aspiration probe connected to a system Pezzer sifonaj underwater equipped with a mechanical valve
– Electric vacuum aspiration with active content

Treatment of complications :
– Hidropneumotorax – resolves spontaneously
– Hemopneumothorax – surgical hemostasis and closure intrapleural rupture of blood discharge
– Piopneumotorax – discharge of pus by puncture of pleural cavity with soil washing NaCl 9 ‰ and antobiotice intrapleural or general surgical drainage in case of failure.

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