Tension pneumothorax means that the patient in milked xe and sometimes inspiratory intrapleural pressure exceeding an atmospheric pressure. The mechanism of development of tension pneumothorax can be compared to one-way valve, koto ing opens at inspiration and closes on exhalation. On inhalation by reducing the respiratory muscles vnutriplevral Noe pressure becomes negative and the air moves from the alveoli into the pleural cavity. As you exhale while relaxing your respiratory muscles, intrapleural pressure becomes positive. Undoubtedly, the valve mechanism by describing in one direction, or exhalation, when on respect to the alveolar pressure intrapleural PRESSURE ofbecomes positive, the air would begin to flow from the pleural cavity and the alveoli of the pressure in the pleural was Lost
Pathophysiological characteristics
The development of intense pneumothorax is usually preceded by an unexpected deterioration in cardiac and pulmonary function. Although this deterioration is usually attributed to a violation of venous WHO gates caused positive intrapleural PRESSURE Niemi, and emerging as a result of low cardiac output, animal experiments have shown that the role of reducing venous return to the deterioration of cardiopulmonary function is minimal. Rutherford et al. Artificially created an intense pneumothorax in goats and young monkeys. In these animal species, the structure of the mediastinum is the same as in humans. Although artificial pneumothorax on was observed pressure increase in the upper and lower hollow ve nah, right atrium, right ventricle and pulmonary artery, a goat it had no effect on heart SEL grew, and in monkeys caused only a slight decrease in its. However, this condition was accompanied by significant respiratory distress and many of the animals died. The genesis of distress is probably associated with a sharp decrease in the Pao2 value . In goats Rao2 decreased on average from 85 to 28 mm Hg. Art., and monkeys – from 90 to 22 mm Hg. Art. In preterminal period the animals were observed respiratory aci doses and delay CO2, the authors associated with cerebral thrust poxvirus [59]. Therefore we can assume that the destructive effect of tension pneumothorax, at least in experiments for Basic animals, probably due to severe hypoxia, Call bath formation of a large shunt kollabirovannom lay com. Experimental studies have shown that reducing of the venous return is a major factor in the development of tension pneumothorax.
Clinical picture
Although in some cases, tension pneumothorax Global Developing etsya spontaneously, most often it occurs as a result of IP artificially ventilation, cardiopulmonary resuscitation, trauma or infection. The clinical picture of a busy pnevmoto Rax is striking in its severity. Patients usually observes expressed camping distress with palpitations difficulty breathing, cyanosis, severe sweating and tachycardia. Gas analysis of arterial blood indicates severe hypoxemia, and in some cases, and respiratory acidosis. “A physical examination reveals signs characteristic of extensive pneumothorax. In addition, there has been the size of the affected hemithorax compared with the contralateral and the expansion of the intercostal spaces. Tra Hay is usually shifted in the contralateral side.
Diagnosis and treatment
The diagnosis of tension pneumothorax should be borne in mind in patients during mechanical ventilation in patients with pneumothorax, as well as in cases of a sharp deterioration of standing patients during handling, which may cause a pneumothorax. If cardiopulmonary resuscitation observed are difficulties in the implementation of mechanical ventilation, it also should be suspected tension pneumothorax. It has been reported [54], that the analysis of the data of 3500 autopsies in 12 cases was detected tension pneumothorax, are not diagnosed during life, 10 of these patients underwent IU -mechanical ventilation and 9 – cardiopulmonary resuscitation.
Diagnosis tension pneumothorax may be SET flax based on X-ray data at considerable prefecture contralateral mediastinal shift and flattening ipsilateral dome diaphragm. However, intense pneumonia motoraks requires urgent action, so do not waste time on the X-ray examinations, as for the diagnosis is usually sufficient to assess the clinical standing of patient data and physical examination. If you suspect that the diagnosis of the patient must Immediate butappoint oxygen to avoid the development of hypoxia. For those over the second intercostal space A large-bore needle should be inserted into the pleural cavity. Optimally, the needle must be connected through three-way stopcock 50 milli- meter syringe partially filled with sterile isotopy nical solution of sodium chloride. The diagnosis of intense pneumothorax is indicated by the rapid flow of air bubbles through the fluid in the syringe.
Thus obtaining a confirmation of the diagnosis tense Nogo pneumothorax, the needle is left in the pleural space until until the air ceases to enter the syringe. In addition, the remaining air can be removed from the pleural cavity with the help of this syringe due to the shut-off valve. Pain Nogo a tension pneumothorax followed immediately prepare for the introduction of drainage. If, after insertion of the needle into the pleural cavity Incoming air bubbles in the syringe is not observed, it means the absence pnevmotorak meat and needle from the pleural cavity must be removed.