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Back to Chest Diseases
Pneumothorax
A pneumothorax or collapsed lung is one
of several types of life-threatening medical emergencies that can result
from a penetrating chest wound or barotrauma to the lungs.
Anatomy
The lungs exist inside the chest cavity, which is a hollow space. Air
is drawn into the lungs by a powerful abdominal muscle called the diaphragm
which separates the chest cavity from the lower internal organs. The pleural
cavity is the region between the chest wall and the lungs. If air enters
the pleural cavity, either from the outside or from the lung, the lung
collapses and it becomes mechanically impossible for the injured person
to breathe, even with a clear airway.
If a piece of tissue forms a one-way valve that allows air to enter the
pleural cavity from the lung but not to escape, overpressure can build
up with every breath; this is known as tension pneumothorax. It may lead
to severe shortness of breath as well as circulatory collapse, both life-threatening
conditions.
Small pneumothoraces often resolve spontaneously and may require no
other treatment than clinical observation. A large pneumothorax or tension
pneumothorax can be a medical emergency.
Causes of pneumothorax
Common causes of pneumothorax are a penetrating chest injurytrauma,
atmospheric overpressure, and preexisting lung disease; a pneumothorax
may also occur spontaneously without apparent cause. A tension pneumothorax
is caused by interior injury to the lung which does not breach the chest
wall, or by an improperly applied dressing for a penetrating chest wound.
Rarely it may result from lung illnesses such as advanced pneumonia or
lung cancer.
Diagnosis of pneumothorax
A person with injuries as above is unable to breathe even though they
have a clear airway. They may spit or cough up blood. They will turn "blue"
and become unconscious. Immediate treatment is required within minutes
or the injured person will die. There may be only one wound (an entrance
wound) or two (an exit wound as well). Both must be treated.
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Treatment of pneumothorax
First Aid
One standard first aid treatment is to cover the wound with pressure
bandage(s) made air-tight with petroleum jelly or clean plastic sheeting.
The sterile inside of plastic bandage packaging is good for this purpose;
however any airtight material, even the cellophane of a cigarette pack,
can be used.
IMPORTANT: do not completely close off the opening. Leave a flap or
corner open so that air does not build up in the lungs yet the patient
can still breathe.
Any patient with a penetrating chest wound must be closely watched
at all times and may develop a tension pneumothorax or other immediately
life-threatening respiratory emergency at any moment. Do not leave them
alone, even for a moment.
Field Care (for EMTs)
Apply airtight pressure bandage(s) as above. Provide oxygen therapy.
Use caution in applying positive pressure ventilation and the use of bag-valve
masks; follow local protocols. Intubation may be required, even of a conscious
patient. Advanced medical care and immediate evacuation are strongly indicated.
Watch carefully for tension pneumothorax. One paramedic procedure to
treat tension pneumothorax is to open a small wound into the chest cavity
with a large hollow needle which can be capped or uncapped as required.
DANGER: if in the mountains or evacuating by air (MEDEVAC), consider
the effects of change of altitude on the patient. If the patient experiences
respiratory distress immediately after a change in altitude, immediately
return to the former altitude. This may require a series of short "hops"
by helicopter until a roadway is reached for ground ambulance transport.
Clinical Treatment
Immediate surgery to close the hole in the chest wall and/or lung.
Supportive therapy including mechanical ventilation. A long period of
hospitalization is likely, including respiratory therapy.
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