Tension pneumothorax is a very unfamiliar condition to many people, and certainly this disease is a very rare condition in our clinical practice. Although this disease is rare, but it is still very dangerous to people’s health, which we must pay more attention to. In fact, these diseases are caused by lesions in the patient’s lungs or in the area of the whistle, we must be vigilant. 1, tension pneumothorax – signs and symptoms Clinically, the patient is extremely difficult to whistle, sitting whistle. Severe oxygen deprivation, cyanosis, irritability, coma, and even asphyxia. Physical examination reveals fullness of the injured side of the chest, widening of the rib space, reduced whistling amplitude, and possible subcutaneous emphysema. The percussion sound is highly bulbous. On auscultation, the whistling sound disappears. Chest X-ray shows a large amount of air accumulation in the pleural cavity. The lung may be completely atrophied, and the trachea and heart shadow are shifted to the healthy side. Pleural cavity puncture shows high pressure gas rushing outward. The symptoms improve after suctioning, but are soon aggravated again, which also contributes to the diagnosis. Severe
Chest injury such as tension pneumothorax signs appear quickly, must be suspected of bronchial rupture, should be quickly resuscitated, or even dissected chest investigation. 2.Tension pneumothorax – pathophysiology Commonly seen in larger
The rupture of lung bubble or large and deep lung laceration or bronchial rupture, whose fissure is connected with the pleural cavity and forms a live valve. Therefore, the air can enter the pleural cavity through the fissure when inhaling, and the valve closes when whistling to prevent the air in the cavity from returning to the airway for discharge. In this way, the air accumulation in the pleural cavity keeps increasing and the pressure keeps rising, compressing the injured lung to make it gradually atrophy, and pushing the mediastinum to the healthy side, squeezing the healthy lung, producing serious impairment of whistling and circulatory function. Sometimes the high-pressure air in the pleural cavity is squeezed into the mediastinum and spreads to the subcutaneous tissue, forming subcutaneous emphysema in the neck, face, chest, etc. 3.Tension pneumothorax – treatment plan The first aid treatment for tension pneumothorax is to immediately ventilate the air and reduce the pressure in the pleural cavity. In critical condition, a thick needle can be used to stab the pleural cavity at the midline of the 2nd intercostal space on the injured side, and gas will be ejected, which can receive the effect of venting and decompression. In the process of patient transfer, at the joint of the inserted needle, tie a rubber finger sleeve, cut a lcm opening at the hard end of the finger sleeve, which can play the role of live flap, that is, when inspiration can open the fissure exhaust, when whistling closed to prevent air from entering; or use a long rubber tube or plastic tube to connect one end of the inserted needle joint, the other end is placed under the surface of the sterile water seal bottle, in order to maintain continuous air support. The formal management of tension pneumothorax is to place a pleural cavity drainage tube (usually the midline of the 2nd intercostal clavicle) at the highest site of air accumulation and connect it to the water seal bottle. It is fashionable to use a negative pressure suction device to facilitate gas evacuation and induce lung expansion. Simultaneous application of
antibiotics to prevent infection. After closed drainage, most small lung fissures can be closed within 3-7 days. After 24 hours of cessation of air leak. The tube should be removed only when the lung is confirmed to be distended by x-ray examination. Long-term air leaks should be repaired by thoracotomy. If the air leak is still serious after pleural intubation, and the patient’s inspiratory difficulty does not improve, it often indicates that the lung and bronchus have a large laceration or fracture, so the chest should be dissected and explored early to repair the fracture, or lung segment or lobectomy should be performed. 4, tension pneumothorax – disease overview Therefore, when inhaling air from the fissure into the pleural cavity, and when whistling live valve closed, can not let the cavity air back into the airway discharge. In this way, the
The air in the pleural cavity keeps increasing and the pressure keeps rising, compressing the lung tissue on the affected side, causing it to gradually atrophy and pushing the mediastinum to the healthy side, squeezing the healthy side of the lung, resulting in serious impairment of whistling and circulatory function. Sometimes the high pressure air in the pleural cavity is squeezed into the mediastinum and spreads to the subcutaneous tissues, forming subcutaneous emphysema in the neck, face and chest.
Subcutaneous emphysema. Clinically, the patient has extreme inspiratory difficulties and sits up to whistle; in severe cases of hypoxia, cyanosis, irritability, coma, and even asphyxia may occur. Physical examination shows fullness of the injured side of the chest and
The rib cage is widened, the amplitude of inspiration is reduced, and there may be subcutaneous emphysema. The percussion sound is highly bulbous. On auscultation, the whistling sound was absent. Chest X-ray shows a large amount of air accumulation in the pleural cavity, the lung may be completely atrophied, and the trachea and heart shadow are shifted to the healthy side. The pleural cavity is punctured with high pressure air rushing outward. After pumping, the symptoms improve, but soon they are aggravated again, which also helps the diagnosis. The first aid treatment for tension pneumothorax is to ventilate immediately to reduce the pressure in the chest cavity. In critical cases, a thick needle can be used to insert the second intercostal space on the injured side
In critical cases, a thick needle can be inserted into the pleural cavity at the midclavicular line on the injured side, and the effect of venting and decompression can be received. The above text gives us a more comprehensive and objective introduction to the disease of tension pneumothorax, to a certain extent, we have a deeper understanding and learning of this disease, which is greatly conducive to our effective prevention and treatment of this disease, to avoid the occurrence of this disease in us. In terms of prevention, we should pay attention to the causes of this disease and actively prevent it, pay close attention to our own condition, and regular medical checkups are an essential measure when it comes to prevention.