Pneumothorax a ɛba ara kwa, Ahurututu mu Nsɛnkyerɛnne a Ɛbubu, ne Pleuritic Chest Eyaw¶

Pneumothorax a ɛba ara kwa (a wɔtaa frɛ no ahurututu a abubu) ba bere a mframa fi ahurututu no mu ntini mu na ɛkɔhyɛ ahurututu no ahunmu, abura a ɛyɛ tratraa a nsu sra mu wɔ ahurututu no akyi ne koko no fasu no mu ntam no mu. Nea ɛnte sɛ ahurututu a abubu a ɛyɛ hu a a mpampam a ɛpaapae anaasɛ koko a opira a ɛnyɛ den anaase a kuru a ɛkɔ mu wɔ koko mu, ahurututu mu yare a ɛba ara kwa no bɔ mpofirim bere a ɔregye n’ahome a ennya nipadua mu nkɛntɛnso biara. Ɛma obi nya koko mu yaw mpofirim, ɛyɛ nnam, na ɛyɛ sekan wɔ ɔfã biako a ɛyɛ kɛse bere biara a ɔhome (pleuritic chest pain) ne ahome a ɛyɛ tiaa mpofirim. Sɛ wususuw sɛ ahurututu a abubu a, frɛ wo mpɔtam hɔ nɔma a egye ntɛmpɛ denam yɛn nɔma ahorow a egye ntɛmpɛ directory ntɛm ara na ma onipa no ntra hɔ tẽẽ na ɔtra hɔ dinn koraa, efisɛ ahurututu biara a abubu betumi asɛe abɛyɛ tension pneumothorax a ɛde nkwa to asiane mu anaasɛ suasua a ahurututu mu ntini a ɛma mogya tu anaasɛ komayare.

Yɛ eyi mprempren¶

1. Frɛ wo mpɔtam hɔ ntɛmpɛ nɔma ntɛm ara: Trɛ 911 wɔ United States ne Canada, 112 wɔ European Union nyinaa, 999 wɔ United Kingdom, 000 wɔ Australia, anaa hwɛ yɛn amanaman ntam nɔma ahorow a egye ntɛmpɛ list. Ka kyerɛ nea ɔde amena no sɛ ɔyarefo no wɔ ɔfã biako a ɛyɛ yaw mpofirim a ɛyɛ nnam wɔ ne koko mu na ne home yɛ tiaa a wosusuw sɛ n’ahurututu abubu (pneumothorax).
2. Fa onipa no si baabi a ɛyɛ fɛ a ɔte hɔ tẽẽ anaasɛ ɔte hɔ fã bi (Fowler gyinabea) anaasɛ fa ne ho to ɔfã a ɛyɛ yaw no so kakra: Sɛ wotra hɔ gyina hɔ tẽẽ wɔ digrii 45 kosi digrii 90 a, ɛde tumi a ɛtwe ade ba fam twe yafunu no akwaa no kɔ fam, na ɛma ahurututu a ennyaa nkɛntɛnso no nya baabi kɛse a ɛbɛtrɛw. Mma nhyɛ ɔyarefo a ne koko yɛ no yaw a ɔhome mfa nna fam wɔ n’akyi da.
3. Gyae nipadua mu mmɔdenbɔ, nantew, ɔfe, anaa nhyɛso nyinaa (Valsalva maneuvers): Mma onipa no nsian antweri nkɔ ambulance no mu, mfa bag nkɔ, mfa nneɛma so, anaasɛ ɔmmɔ ne hwene denneennen. Ahome, ɔfe, anaa Valsalva a ɛyɛ den biara ma mframa pii fa ahurututu mu ntini a apaapae no mu kɔ koko no mu na ɛma ahurututu no hwe ase ntɛmntɛm.
4. Saan ntade a ɛyɛ den wɔ wo moma so, kɔn, ne w’asen mu na ma wɔn home dwo: Bue kɔla ahorow, gyae abɔso anaa bras a ɛyɛ den, na kyerɛkyerɛ ahome a ɛyɛ brɛoo, ɛnyɛ den, na ɛyɛ komm. Ehu a ɛma obi home kɔ akyiri no ma ahurututu mu nhyɛso a ɛsakra no yɛ kɛse na ɛma ɛyaw a wɔde sekan bɔ no mu yɛ den.
5. Fa oxygen a ɛsen kɛse a wɔde ka ho ma sɛ wɔatete no na wɔde nneɛma ahyɛ mu a: Sɛ oxygen cylinder a ɛsen ntɛm a ɛwɔ akataso a ɛnyɛ nea ɛsan home wɔ adwumayɛbea, hyɛmma a wɔde hyɛ nsu mu, anaa ayaresabea a, fa oxygen a ɛsen kɛse ma lita 10 kosi 15 simma biara (gye sɛ ɔyarefo no nim sɛ carbon dioxide a ɛtra hɔ daa fi COPD a emu yɛ den mu, na wɔ saa tebea no mu no, wode w’ani si oxygen saturation a ɛyɛ den so Ɔha biara mu nkyem 88 kosi 92 kosi sɛ nnuruyɛfo a wɔboa nkurɔfo bɛba a wɔbɛhwɛ mogya mu mframa so). Oxygen a ɛsen kɛse no siesie mogya mu oxygen a ɛba fam (hypoxemia) na ɛma ahurututu mu nitrogen a wɔakyere no no san twetwe ntɛmntɛm mpɛn anan.
6. Hwɛ bere nyinaa sɛ Tension Pneumothorax no frankaa kɔkɔɔ no: Hwɛ onipa no kɔn, n’ano, ne koma bɔ, ne n’adwene mu ani da hɔ simma 2 biara. Sɛ wɔbɛyɛ cyanotic kɛse (anofafa bruu), wɔn adwene tu fra, wɔn adwene tu fra, wɔn mogya so tew, wɔhome soronko, anaasɛ wɔn kɔn mu ntini a ɛtrɛw a, ka kyerɛ wɔn a wɔde wɔn kɔ ntɛm ara no ntɛm ara sɛ ɔyarefo no resɛe abɛyɛ nea wosusuw sɛ ɛyɛ tension pneumothorax a ɛhwehwɛ sɛ wɔma ɔyarefo no de nede gyae ntɛm ara.
7. Bara wimhyɛn akwantu, mmepɔw so cable car, ne scuba diving nyinaa: Sɛ mpo te nka sɛ ne koko mu yaw nyɛ den na wotumi di ho dwuma a, ɛnsɛ sɛ obi a ɔwɔ pneumothorax a wɔansa no yare anaasɛ onsii so dua ɔnforo wimhyɛn da, ɔka kar fa mmepɔw atenten a ɛtwam so, anaasɛ ɔnhyɛn nsu mu nkɔhwe ase, efisɛ nhyɛso nsakrae a Boyle Mmara kyerɛ so no bɛtrɛw koko mu mframa a akyere no mu na akanyan cardiovascular a edi awu ahwe ase.

Gyinaesi dua: Pleuritic koko mu yaw a ɛba mpofirim wɔ ɔfã biako ne pneumothorax triage¶

flowchart TD
    Start["Koko mu Ɛyaw a Ɛyɛ Nnam Mpofirim a Ɛwɔ Ɔfã Baako (Ɛyɛ Kɛse wɔ Nkannyan Ho) ne Ɔhome Tiaa a Ɛyɛ Den (No Chest Trauma) ."] --> TensionCheck{"So Tension Pneumothorax Red Flags BIARA Wɔ Hɔ? 1. Mframa ho kɔm a ɛtra so anaasɛ ontumi nkasa 2. Anofafa bruu (cyanosis), SpO2 a ɛba fam 90% 3. Mframa a ɛbɔ ntɛmntɛm a ɛyɛ mmerɛw (boro 120 bpm), mogya mmoroso, anaasɛ syncope 4. Ne kɔn mu ntini a ɛtrɛw anaa mframa a ɛtwetwe 5. Ɔyarefo no wɔ COPD, ayamtu a emu yɛ den, anaa mframa a ɛma obi nya nhyɛso pa"}

    TensionCheck -->|"YIW: Nkwa a Ɛde Ahunahuna a Ɛba Ntɛm ara"| TensionProtocol["SUSPECTED TENSION PNEUMOTHORAX ANAA SECONDARY SPONTANEOUS PNEUMOTHORAX: 1. Frɛ 911 / 112 / 999 STAT na pae mu ka sɛ Suspected Tension Pneumothorax 2. Ma ɔyarefo no ntra hɔ gyina hɔ (digrii 45 kosi 90) na ɛnyɛ den koraa 3. Fa O2 a ɛkɔ soro (10 kosi 15 L/min) gu so via non-rebreather;"]

    TensionCheck -->|"DABI: Hemodynamically stable, kasa kasamu a edi mũ, normal pulse"| RiskProfile{"Hwɛ Ɔyarefo Asiane Ho Nsɛm: Mfitiase (PSP) vs Nea Ɛto so Abien (SSP) vs Catamenial"}

    RiskProfile -->|"Mmabun (15 kosi 35 yrs), tenten/teateaa, sigaretnom/vaper, na onni ahurututu mu yare biara"| PSP["Wosusuw sɛ Ɛyɛ Pneumothorax a Ɛwɔ Hɔ Mfitiase (PSP): apical subpleural bleb a apaapae"]
    RiskProfile -->|"Mfeɛ boro mfeɛ 50, ANAA abakɔsɛm a ɛfa COPD, emphysema, ayamtu, cystic fibrosis, Marfan"| SSP["Suspected Secondary Spontaneous Pneumothorax (SSP): Ahurututu mu akorae a ɛba fam na asiane kɛse wom sɛ ɛbɛsɛe ntɛmntɛm"]
    RiskProfile -->|"Ɛba wɔ nnɔnhwerew 72 ansa na brayɛ afi ase anaasɛ ɛno akyi"| Catamenial["Wosusuw sɛ Catamenial / Thoracic Endometriosis Pneumothorax: Mpɛn pii no, ɛyɛ nifa so (bɛboro 90%) ."]

    PSP --> HospitalEval["Nneɛma a Wɔde Kɔ Ayaresabea ED a Wɔde Kɔ Ayaresabea a Wɔte Ase (NNantew anaa Nyɛ Apɔw-mu-teɛteɛ): Fa Upright Inspiration Chest X-Ray, Thoracic Ultrasound (ahurututu a ɛtwetwe a enni hɔ), anaa CT so si ne kɛse so dua"]
    SSP --> HospitalEval
    Catamenial --> HospitalEval

    HospitalEval --> SizeBranch{"Ayaresabea Nhwehwɛmu a Wɔyɛ no Kɛse ne Nsɛnkyerɛnne (BTS / ATS / ERS Akwankyerɛ) ."}

    SizeBranch -->|"PSP nketewa (a ɛwɔ 2 cm rim ase wɔ hilum) NA ahome a ɛnyɛ den koraa anaasɛ enni hɔ koraa"| Conservative["Conservative Observation + High-Flow Oxygen Therapy: Ɛsan twetwe 1.25% kosi 2% da biara (4x ntɛmntɛm wɔ high-flow O2 so) Tia X-ray wɔ nnɔnhwerew 4 kosi 6 mu, afei fa ayarefo a wɔda abɔnten di akyi a NO FLYING mmara a emu yɛ den"]
    SizeBranch -->|"PSP Kɛse (2 cm rim anaa nea ɛboro saa) ANAA Ɔhome a Ɛmma Ahome ANAA Secondary Pneumothorax (SSP) Biara ."| Intervention["Active Pleural Decompression: - Simple Needle Aspiration (14G kosi 16G cannula) ANAA Ambulatory Heimlich Valve Device - Small-Bore Seldinger Chest Tube (8 kosi 14 Fr) a wɔde abɔ nsu ase nsɔano - VATS pleurodesis sɛ mframa kɔ so tu (bɛboro nnafua 3 kosi 5), adwuma a ɛsan ba bio, anaasɛ asiane kɛse wom a"]

Pathophysiology: Sɛnea ahurututu bi bubu a enni koko mu apirakuru¶

Wɔ ahurututu a ɛte apɔw mu no, ahurututu no akyi (visceral pleura) ne ribcage no mu fasu (parietal pleura) bata ho wɔ ahurututu mu nsu a ɛyɛ tratraa (mililita 10 kosi 20 [nsu ounces 0.3 kosi 0.7]) so. Esiane sɛ ahurututu a ɛyɛ den no fi awosu mu san n’akyi kɔ mu bere a mpampam no twe kɔ akyi nti, ahunmu a ɛda saa ntini abien yi ntam no kɔ so kura wim tebea ase (a enye) ahurututu mu nhyɛso a ɛkɔ so daa a ɛyɛ -3 kosi -5 cmH2O bere a wɔagye n’ahome, na ɛkɔ fam kodu -8 kosi -10 cmH2O bere a wɔhome kɔ akyiri no. Saa vacuum suction a enye yi ma mframa kotoku (alveoli) no kɔ so yɛ hyew wɔ mpampam no so.

1. Apical Blebs, Bullae, ne Pleural Suction a Ɛnyɛ Den a Ɛyera¶

Mframa kotoku nketewa a ɛte sɛ akisikuru a wɔfrɛ no subpleural blebs (a ne kɛse nnu sɛntimita 1 kosi 2, wɔ visceral pleura no mu) anaa emphysematous bullae akɛse (bɛboro sɛntimita 1 kosi 2, a alveolar afasu a asɛe na ɛyɛe) taa nyin wɔ soro (apex) . a ɛwɔ ahurututu mu ntini a ɛwɔ soro no mu.

Tumi a ɛtwe ade ba fam no twe ahurututu no nnyinaso a emu yɛ duru no kɔ fam kɔ ​​ahurututu no mu. Wɔ obi a ne moma so a ɛyɛ teateaa (a ɛyɛ ectomorphic build) mu no, ahurututu no sorokɔ a ɛda hɔ gyina hɔ no ma pleural pressure gradient a ɛyɛ toro (0.25 cmH2O wɔ ahurututu sorokɔ sɛntimita biara mu). Ntini a ɛwɔ ahurututu no atifi pɛɛ no ​​nya nhyɛso a enye a ɛtwetwe a ɛtrɛw sen ahurututu a ɛwɔ ase no, na ɛtrɛw apical tissue no mu kosi sɛ subpleural blebs a ɛyɛ tratraa bɛba.

Sɛ apical bleb bi mu paapae fa visceral pleura no mu a, ɔkwan bi bue wɔ mframa kwan no ne pleural cavity a nhyɛso bɔne wom no ntam: 1. Mframa de ahopere fi ahurututu no mu kɔ ahurututu no mu kosi sɛ ahurututu a enye no bɛyera na ahurututu no mu nhyɛso ne wim nhyɛso (0 cmH2O) bɛyɛ pɛ. 2. Bere a wɔayi ne vacuum tether a ɛwɔ akyi no afi hɔ no, ahurututu a ɛyɛ den no san n’akyi kɔ mu kɔ ne mfinimfini ntini (hilum) no so, na ɛhwe ase fã bi anaa ne nyinaa. 3. Ahurututu mu ntini a abubu no gyae sɛ ɛde ne ho bɛhyɛ mframa a wɔde sesa mu, na ɛma mframa-nsu (V/Q) nhyia ne nifa-kɔ benkum shunt kosi sɛ hypoxic pulmonary vasoconstriction bɛdan mogya a ɛkɔ ahurututu a ɛwɔ apɔwmuden no mu.

2. Nea Enti a Oxygen a Ɛsen Kɛse no Ma Ɛsan Fa Ntɛmntɛm Ɔha biara mu 400 (Nitrogen Hohoro) .¶

Bɛyɛ ahurututu mu mframa a wɔakyere no ɔha biara mu nkyem 78 yɛ nitrogen (N2), mframa a ɛnyɛ adwuma a ɛnkɔ mogya mu yiye. Wɔ dan mu mframa a wɔhome a ɛfata ase no, ahurututu mu ahurututu a ɛba ara kwa a wɔato mu no san kɔ ahurututu no mu ntini a ɛwɔ ahurututu no mu no mu wɔ hemithorax no dodow ɔha biara mu nkyem 1.25 kosi 2.2 pɛ wɔ nnɔnhwerew 24 biara mu (a ɛkyerɛ sɛ ɔha biara mu nkyem 30 a ɛhwe ase no gye adapɛn 2 kosi 3 ansa na n’ankasa ayɛ yiye).

Sɛ nnuruyɛfo a wɔboa anaa nnuruyɛfo a wɔhwɛ ntɛmpɛ so de oxygen a ɛsen kɛse (lita 10 kosi 15 simma biara denam akataso a ɛnyɛ nea ɛsan home so) gu wɔn ho a, oxygen a wɔde honhom kaa no no hohoro nitrogen fi ntini mu mogya a ɛkyinkyini mu, na ɛma nitrogen nhyɛso fã bi a ɛwɔ ahurututu mu ntini a ɛwɔ ahurututu mu no so tew fi bɛyɛ 573 mmHg kɔ zero bere a ntini mu oxygen no yɛ nea ntini ahorow no di. Eyi ma nhyɛso fã bi a ɛtrɛw a ɛyɛ den ba wɔ ahurututu kotoku a nitrogen pii wom ne mogya a ɛwɔ ntini a nitrogen ayɛ mu ma no ntam, na ɛtwe mframa a wɔakyere no fi ahurututu no mu **ntɛmntɛm mmɔho anan (ɛkɔ hemithorax dodow ɔha biara mu nkyem 4 kosi 8 da biara).

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Bere a wɔde ahurututu mu yare a ɛba ara kwa no ahorow anan a ɛwɔ ayaresabea no toto ho¶

Sɛ wɔte ɔfã a ɔyarefo bi hyɛ mu ase a, ɛkyerɛ sɛnea wɔpaw nnipa, efisɛ ebia ɛbɛyɛ te sɛ nea agumadifo kumaa a ɔwɔ apɔwmuden a ne ho atɔ no ɔha biara mu nkyem 25 no ho tɔ no bere a ɔregye n’ahome, bere a obi a wadi mfe 65 a ɔwɔ emphysema na ɔhwe ase ɔha biara mu nkyem 10 betumi anya hypoxic arrest ntɛmntɛm.

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Nsɛnkyerɛnne a wohu: Ɔhwe ase a ɛnyɛ den vs. Tension Pneumothorax¶

1. Nsɛnkyerɛnne a Ɛyɛ Tete a Ɛkyerɛ sɛ Ahurututu Mu Ahurututu a Ɛyɛ Mmerewa a Ɛba Ara¶

Wɔ bɛboro ɔha biara mu nkyem 80** mu no, ahurututu mu yare titiriw a ɛba ara kwa no ba bere a wɔagye wɔn ahome sen sɛ wɔbɛyɛ bere a wɔreyɛ apɔw-mu-teɛteɛ denneennen: - Eyaw a ɛba mpofirim, ɛyɛ nnam, a ɛyɛ sekan wɔ ɔfã biako (Pleuritic Pain): Sɛ wohome denneennen, ɔfefe, serew, anaasɛ wobɛkyinkyim wo honam ani a, ɛma obi kyere a ano yɛ nnam a ɛhyɛ ahome ntiantiaa a emu nnɔ ("splinting"). - Ipsilateral shoulder-tip anaa upper back (scapular) pain: Esiane sɛ parietal pleura a ɛkata mfinimfini diaphragm no so no, phrenic nerve (cervical roots C3, C4, ne C5) na ɛma ntini no yɛ adwuma nti, wɔde abufuw a efi mframa a ɛreguan mu ba no kɔ mmati no atifi wɔ ɔfã koro no ara. - Ahome tiaa a ɛyɛ hu (Dyspnea): Efi mframa ho kɔm a emu nyɛ den so wɔ antweri so kosi ahoyeraw a ɛyɛ hu bere a ɔregye n’ahome so. - Dry, hacking, non-productive cough: Ɛnam pleural stretch receptors so na ɛkanyan bere a ahurututu no mu mframa fi mu no. - Subcutaneous emphysema ("Rice Krispies" crackles under the skin): Mframa a ɛdi akyi kɔ mediastinum (pneumomediastinum) ne kɔn mu no ma crackling wɔ nsateaa ase anaasɛ nnyigyei a ɛyɛ crunching a koma no bɔ (Hamman's sign). - Apɔw-mu-teɛteɛ mu nhwehwɛmu: Ɔfã a ɛka no no ntumi nkɔ baabiara bere a wɔrehome no, ɛte sɛ tokuru bere a wɔabɔ no (hyperresonance to percussion), na ɔhome nnyigyei a ɛso atew anaasɛ enni hɔ wɔ auscultation mu.

2. Nkɔso a ɛkɔ Tension Pneumothorax mu: Ɔkwan Baako Valve Emergency¶

tension pneumothorax ba bere a ahurututu mu ntini a atetew no yɛ adwuma sɛ akwan biako valve: sɛ wɔhome no twe mframa fi ahurututu mu dua no mu kɔ ahurututu no mu, nanso sɛ wɔhome a, ɛkata flap no mu ma enti mframa ntumi mfi mu.

Bere biara a wɔhome no, nhyɛso pa kɔ soro wɔ koko no mu (+10 kosi +20 cmH2O anaa nea ɛboro saa): 1. Complete ipsilateral lung collapse: Wɔabubu ahurututu a ɛka no no petee wɔ hilum no so. 2. Mediastinal shift and compression of the opposite lung: Nhyɛso a ɛkɔ soro no pia koma no, mframa nhama (trachea), ne ntini akɛse no fa mfinimfini kwan no so kɔ ɔfã a ɛwɔ apɔwmuden no mu, na ɛhyɛ ahurututu a aka no mu. 3. Kinking of the Vena Cava and Obstructive Shock: Nhyɛso pa a ɛba ahurututu mu no piapia vena cava a ɛwɔ soro ne nea ɛwɔ fam no mu. Venous san kɔ nifa atrium no so tew kodu zero, koma no mu nsu a ɛba no so tew kɛse ma ɛbɛyɛ obstructive shock, na ɔyarefo no hu amane wɔ Pulseless Electrical Activity (PEA) koma no mu a ɛgyae wɔ simma kakraa bi mu gye sɛ wɔde needle decompression anaa chest tube na ɛma mframa fi mu.

Nsonsonoe a ɛda Simple Pneumothorax ne Tension Pneumothorax a ɛwɔ mpa ho no ntam¶

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Nsonsonoe a wɔde hu: Nneɛma afoforo a ɛde pleuritic chest pain ba¶

Nnuruyɛfo a wɔboa nkurɔfo ne nnuruyɛfo a wɔhwɛ ntɛmpɛ so de nhyehyɛe hwehwɛ koko mu nsɛm a egye ntɛmpɛ a ɛka bom mu:

1. ** Ahurututu mu Ntini a Ɛyɛ Fɛ (PE) .: Mogya a ɛtwetwe fi ntini a emu dɔ (DVT) mu kɔ ahurututu mu ntini mu no ma ɛyɛ yaw mpofirim wɔ ahurututu mu, ɔhome a ɛyɛ den, na ɛma koma no yɛ mmerɛw. Nea ɛnte sɛ pneumothorax no, ɔhome nnyigyei yɛ pɛ wɔ afã abien no nyinaa, ayarefo betumi afe mogya (hemoptysis a ɛma mogya tu), na nneɛma a ɛde asiane ba no bi ne oprehyɛn a wɔayɛ nnansa yi, wimhyɛn a wɔde tu kwan bere tenten, nea wontumi nkɔ baabiara, nyinsɛn, anaa kokoram.
2. ** Pericarditis a Ɛyɛ Hu ne Myocarditis: Ɛma mfinimfini anaa benkum pleuritic koko mu yaw a ano yɛ nnam a ɛhyerɛn kɔ trapezius ridge a ɛyɛ kɛse bere a ɛda fam no na ɛyɛ yiye bere a ɔte hɔ na ɔde ne ho kɔ n’anim, a ɔhome nnyigyei a ɛfata wɔ afã abien.
3. ** Koma a Ɛyare na Aortic Ntini a Wɔde Twitwa: Myocardial infarction ma squeezing retrosternal pressure a emu yɛ duru ba, bere a aortic dissection ma ɛyaw a ɛtetew mpofirim a ɛhyerɛn kɔ akyi (ɛho hia sɛ wopow wɔ Marfan syndrome mu, a ɛma ɛyɛ mmerɛw sɛ wobenya pneumothorax ne aortic dissection nyinaa).
4. Esophageal Rupture (Boerhaave Syndrome): Ɛyɛ transmural esophageal tete bere a wɔafe denneennen akyi, na ɛma yafunu mu acid ne mframa kɔ mediastinum ne benkum pleural cavity mu.

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Ɔhwɛ a wɔde ma ansa na wɔakɔ ayaresabea ne ayaresabea: Nea wobɛhwɛ kwan afi nnuruyɛfo a wɔboa nkurɔfo ne ED hɔ¶

1. Nea Enti a Positive-Pressure Ventilation (CPAP, BiPAP, anaa BVM) Yɛ Asiane Ansa na Wɔbɛma Mframa Ahorow Mu¶

Sɛ ɔyarefo bi a ɔwɔ ahurututu mu yare a wonnya nhui no home a, CPAP, BiPAP, anaa ahoɔden bag-valve-mask (BVM) mframa a wɔde gu so no de mframa a wɔahyɛ no den fa ahurututu no mu tetew mu kɔ ne koko no mu, na ɛdan ahurututu a ɛyɛ mmerɛw a ɛhwe ase no ma ɛbɛyɛ ahurututu mu ahurututu a ɛyɛ hu. Wɔn a wɔyɛ mmuae no tie ahurututu abien no nyinaa bere nyinaa (na wɔde mpa ho ultrasound di dwuma) ansa na wɔde mframa kwan mu nhyɛso pa ahyɛ wɔn ho.

2. Ayaresabea Nhwehwɛmu: Koko so X-Ray a Ɛteɛ ne Thoracic Ultrasound (POCUS) .¶

• Upright Posteroanterior (PA) Chest X-Ray: Ɛkyerɛ nsensanee fitaa a ɛyɛ nnam (visceral pleural edge) a ahurututu mu agyiraehyɛde biara nni hɔ wɔ nhama no ho. Ɛho nhia sɛ wɔyɛ sini ahorow a wɔyɛ daa a wɔde home.
• Point-of-Care Thoracic Ultrasound (POCUS): Ɛhu ahurututu mu yare wɔ nea ennu sikani 30 mu a ɛyɛ nkate a ɛkorɔn sen supine X-ray. Ahurututu a abubu kyerɛ ahurututu a ɛtwetwe nni hɔ, comet-tail B-lines nni hɔ, barcode "stratosphere sɛnkyerɛnne" wɔ M-mode so, ne diagnostic "lung point".

3. Nnɛyi Ayaresa a Wɔpaw: Hwɛ, Aspiration, Chest Tubes, ne VATS¶

Nea ɛne 2023 British Thoracic Society (BTS) Pleural Disease Guideline ne amanaman ntam sɔhwɛ ahorow hyia:

1. Conservative Management (Observation Alone): Wɔ ayarefo nkumaa, a wɔwɔ apɔwmuden a wɔwɔ Primary Spontaneous Pneumothorax (PSP) a wɔwɔ ahome a ɛyɛ den kakraa bi anaasɛ wonni bi ne vitals a ɛyɛ pintinn no, oxygen a ɛsen kɛse a wɔde hwɛ ne koko X-ray a wɔsan yɛ bio wɔ nnɔnhwerew 4 mu no ma ahurututu mu nusu no sa fi awosu mu a wɔmfa ade anaa afiri biara nni mu.
2. Simple Needle Aspiration anaa Ambulatory Heimlich Valve: Wɔ PSP ayarefo a wontumi home fam no, nnuruyɛfo betumi afa 14G to 16G cannula (ɛkɔ lita 2.5 [2.6 quarts]) so agye mframa anaasɛ wɔde ambulatory pleural vent a ɛwɔ ne ho (8 Fr catheter a ɛwɔ Heimlich flutter valve a ɛkɔ ɔkwan biako so) ahyɛ mu ama ayarefo a wɔda abɔnten ntrɛwmu wɔ nnafua 2 kosi 4 mu.
3. Small-Bore Seldinger Intercostal Chest Drain (8 Fr to 14 Fr): Wɔ Secondary Spontaneous Pneumothorax (SSP), aspiration a entumi nyɛ yiye, anaasɛ sɛnkyerɛnne akɛse a ɛhwe ase ho no, nnuruyɛfo de 8 kosi 14 French Seldinger catheter hyɛ mpɔtam hɔ aduru a wɔde kum nipadua no ase denam "Triangle of Safety" (wɔde hye so pectoralis major, latissimus dorsi, 5^th intercostal space, ne axilla), a ɛbata nsu ase nsɔano toa ho.
4. Emergency Needle Decompression (Thoracostomy): Sɛ wopɛ tension pneumothorax a ɛyɛ ahodwiriw a, ayaresabea adwumayɛfo de cannula a ɛwɔ tokuru kɛse (14G, ne tenten yɛ sɛntimita 4.5 kosi 8 [sentimita 1.75 kosi 3.25]) hyɛ 2^nd intercostal space midclavicular line anaa 4^th anaa 5^th intercostal space no mu anterior to the midaxillary line (wɔ atifi mpampam ano no atifi pɛɛ), na mframa a ɛkyere nhyɛso no fi mu ntɛm ara.
5. Oprehyɛn a Wɔde Siw Ano a Ɛsan Ba (VATS Bullectomy ne Pleurodesis): Sɛ mframa a ɛkɔ so tu (boro nnafua 3 kosi 5), pneumothorax a ɛsan ba, anaasɛ adwuma a asiane kɛse wom (pilots, divers), Video-Assisted Thoracoscopic Surgery (VATS) staples apical blebs (bullectomy) na fuses the pleura via abrasion, pleurectomy, anaa talc poudrage, na ɛtew nea ɛsan ba no so fi ɔha biara mu nkyem 30 kosi 50 kosi ɔha biara mu nkyem 1 kosi 5.

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Bepɔw a ɛkorɔn, wimhyɛn akwantu, nsu mu a wɔde wɔn ho hyɛ mu, ne sɛnea wosiw ano bere a wɔn ho atɔ wɔn akyi¶

Sɛ ahurututu mu yare a ɛba ara kwa no sa yare na wogyae ɔyarefo no fie a, mmara a emu yɛ den a ɛfa mframa ho ne asetra kwan ho bɔ ho ban fi ɔyare a ɛsan ba a ebetumi akum no ho:

• Aguadi Wimhyɛn Akwantu a Wɔtwɛn Mmara (BTS & Aerospace Medical Association):
• Ɛnsɛ sɛ WODE ahurututu mu ahurututu mu yare a ɛyɛ adwuma, ɛka, anaasɛ wɔansa no yare a ne kɛse biara tu wimhyɛn DA.
• Sɛ ayaresa akyi koko so X-ray si so dua sɛ ɔha biara mu nkyem 100 radiographic resolution a edi mũ (ahurututu no atrɛw koraa atia koko no fasu a mframa kotoku a aka biara nni mu) a, Britania Thoracic Society kamfo kyerɛ sɛ anyɛ yiye koraa no nnafua 7 mũ nyinaa wɔ X-ray a ɛfata akyi (na wimhyɛn adwumayɛkuw pii ne Aerospace Medical Association kamfo kyerɛ sɛ ɛsɛ sɛ wɔtwɛn nnafua 14 wɔ radiographic resolution a edi mũ akyi) ansa na wɔaforo wimhyɛn a wɔde di gua, na wɔahwɛ sɛ saa fragile visceral pleural scar ntumi mmue bere a cabin nhyɛso so tew wɔ beae a ɛkorɔn no.
• Scuba Diving Anohyeto a Ɛtra hɔ Daa:
• Esiane sɛ sɛ obi foro fi asuguarebea a emu nnɔ mpo a ne tenten yɛ mita 10 (anammɔn 33) anaa po mu a, ɛma mframa biara a wɔakyere no dɔɔso mmɔho abien na ebetumi ama obi anya ahurututu mu barotrauma ne arterial gas embolism (AGE) a edi awu nti, abakɔsɛm a ɛkyerɛ sɛ obi anya ahurututu mu yare a ɛba ara kwa no yɛ abirabɔ koraa daa sɛ ɔde mframa a wɔahyɛ no den bɛkɔ nsu ase wɔ nsu mu bilateral surgical pleurectomy na ɔtwam wɔ koko mu CT a ɛyɛ soronko a ɛyɛ fɛ ne ahurututu mu dwumadi a wɔayi afi hɔ wɔ asuguare mu aduruyɛ ho ɔbenfo bi nkyɛn.
• Gyae Sigaretnom ne Vaping Koraa:
• Sɛ wɔkɔ so nom tawa sigaret, wii nkwaa/bongs (a ɛfa Valsalva a wɔhome kɔ akyiri na wɔhome bere tenten), anaa ɛlɛtrɔnik sigaret/vapes ne ade biako pɛ a wotumi sesa no ma ɛsan ba bio. Wusiw ne mframa a wɔhome nyinaa a wogyae no ma asiane a ɛwɔ hɔ sɛ ahurututu a ɛto so abien a abubu no so tew fi bɛboro ɔha biara mu nkyem 40 kosi 50 kosi bɛyɛ ɔha biara mu nkyem 15 kosi 20.
• Kwati Nneɛma a Ɛyɛ Den, Mframa Nnwinnade, ne Nkitahodi Agumadi Adapɛn 2 kosi 4:
• Twɛn kosi sɛ radiographic ho bɛtɔ wo koraa na w’ahurututu ho oduruyɛfo no begye no afi hɔ ansa na woasan akɔ nneɛma a emu yɛ duru a wɔma so (kwati Valsalva a wɔma so a ɛma wohome), kɔbere anaa nnua mfiri a ɛko tia kɛse, anaasɛ wode wo ho bɛhyɛ agumadi a wɔde di nkitaho mu.

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Mpɔtam hɔ ntɛmpɛ nɔma ne adwumakuw no nhyehyɛe ahorow¶

• United States ne Canada: Frɛ 911 ntɛm ara sɛ wowɔ pleuritic chest ɛyaw mpofirim ne ahome a ɛyɛ tiaa. Nnuruyɛfo a wɔboa ansa na wɔakɔ ayaresabea di Amerika Koma Fekuw (AHA) ne Prehospital Trauma Life Support (PHTLS) / National Association of EMS Physicians (NAEMSP) nhyehyɛe ahorow a ɛfa oxygen a ɛsen kɛse a wɔde ma, pulse oximetry, ne ntɛmpɛ needle thoracostomy (2^nd intercostal space midclavicular line anaa 4^th/5^th intercostal space anterior axillary line) akyi sɛ nhyɛso nipadua ho adesua nya nkɔso. Ayaresabea sohwɛ di American Thoracic Society (ATS) ne American College of Chest Physicians (CHEST) akwankyerɛ akyi.
• United Kingdom: Frɛ 999 ma ambulance a egye ntɛmpɛ (koko mu yaw a emu yɛ den a ɔhome a ɛyɛ den no yɛ 999 frɛ bere nyinaa). Ayaresabea hwɛ di British Thoracic Society (BTS) 2023 Guideline for Pleural Disease ne NICE gyinapɛn ahorow akyi, a ɛkyerɛ sɛnea wɔhwɛ so yiye, ahurututu mu mframa a wɔde fa ayarefo a wɔda abɔnten a wɔde nantew, ne Seldinger koko mu nsu a ɛwɔ tokuru nketewa mu.
• European Union: Frɛ 112 wɔ EU aman nyinaa mu. Ayaresabea akuw di European Respiratory Society (ERS) adwumakuo no ayaresabea dwumadie akwankyerɛ a ɛfa ahurututu mu akisikuru a ɛba ara kwa ho mfitiaseɛ ne deɛ ɛtɔ so mmienu no akyi, de mpa ho ahurututu mu ultrasound, dijitaal koko mu nsuo a wɔde yi nsuo ho nhyehyɛeɛ, ne VATS a wɔde ma ntɛm di dwuma.
• Australia ne New Zealand: Frɛ 000 wɔ Australia anaa 111 wɔ New Zealand. Ambulance dwumadie ne dwumadie a ɛhwɛ ntɛmpɛ so di Thoracic Society of Australia and New Zealand (TSANZ) ne Australia ne New Zealand Committee on Resuscitation (ANZCOR) akwankyerɛ akyi, de nhumu a ɛfiri ANZ multi-center conservative vs. interventional PSP sɔhwɛ a ɛyɛ nwonwa no mu ka ho.
• India ne Asia-Pacific: Trɛ 112 wɔ India, 995 wɔ Singapore, 119 wɔ Japan ne South Korea, anaa 999 wɔ Hong Kong ne Malaysia. Bisa Advanced Life Support (ALS) ambulance a wɔde oxygen ahyɛ mu ma na ka kyerɛ dwumadibea a egye ntɛmpɛ a wogye no sɛ wonsiesie wɔn ho mma wo koko so radiography a ɛteɛ ne pleural decompression.

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Nsɛm a wɔtaa bisa¶

Dɛn nti na mmerante atenten a wɔyɛ teateaa a wɔwɔ wɔn mmabunbere ne aduonu mu no taa nya ahurututu a ɛtɔ ara kwa?¶

Bere a mmabun nyin ntɛmntɛm no, koko a ɛware na ɛyɛ teateaa ma tumi a ɛtwe ade ba fam no kɔ soro a ɛyɛ toro fi ahurututu no atifi kɔ ne nnyinaso. Mframa kotoku (alveoli) a ɛwɔ ahurututu no atifi pɛɛ no ​​nya nhyɛso a enye a ɛtrɛw sen ahurututu no fã a aka no, na ɛma ahurututu no ase ntini nketenkete a ɛte sɛ akisikuru ba wɔ soro ntini no atifi. Sɛ saa apical blisters a ɛyɛ tratraa yi biako mu paapae (titiriw sɛ mframa kwan nketenkete a ɛyɛ hyew a efi sigaretnom anaa vaping mu ba no ma ɛyɛ mmerɛw a) a, mframa tu kɔ ahurututu no mu na ɛma ahurututu no bubu bere a ɔte hɔ dinn mpo.

Bere tenten ahe na bere a wɔasa ahurututu a abubu no yare akyi no, so asiane biara nni ho sɛ wobɛfa wimhyɛn a wɔde di gua mu?¶

Ɛnsɛ sɛ woforo wimhyɛn da bere a ahurututu mu ahurututu mu yare biara a aka da so ara wɔ wo koko X-ray mu, efisɛ nhyɛso a ɛwɔ wimhyɛn no mu sorokɔ mu no ma koko mu mframa a wɔakyere no trɛw ɔha biara mu nkyem 25 kosi 38. Sɛnea Britania Thoracic Society (BTS) kyerɛ no, anyɛ yiye koraa no, ɛsɛ sɛ wotwɛn nnafua 7 mũ nyinaa bere a wo koko so X-ray a wɔde di akyi no akyerɛ sɛ ahurututu mu yare no asa koraa ɔha biara mu nkyem 100 (na wimhyɛn adwumayɛkuw pii ne Ahunmu Aduruyɛ Fekuw no hwehwɛ sɛ wotwɛn nnafua 14 wɔ radiographic a edi mũ akyi) ansa na woatu wimhyɛn no.

So metumi asan akɔ nsu mu bio bere a manya ahurututu mu yare a ɛba ara kwa awie no?¶

Wɔ British Thoracic Society, Divers Alert Network (DAN), ne amanaman ntam asuguare ho aduruyɛ ho akwankyerɛ ase no, ahurututu mu yare a ɛba ara kwa a atwam no yɛ nea ɛmma wɔmfata koraa sɛ wɔmfa mframa a wɔahyɛ no den nkɔ nsu mu, bere mpo a ahurututu no asa koraa na mpo wɔ talc anaa abrasion pleurodesis a wɔtaa de di dwuma akyi mpo. Nsakrae a ɛtra so a ɛba nhyɛso mu wɔ nsu ase no betumi apaapae nsu nketenkete a ɛwɔ ahurututu no mu biara mu na atrɛw mframa a wɔakyere no mu ɔha biara mu nkyem 200 kosi 400 bere a wɔreforo no, na ɛde ahurututu mu nhyɛso a edi awu aba ansa na adu nsu no ani; wɔn a wɔntaa nnya oprehyɛn a wɔayɛ wɔn ahurututu mu oprehyɛn wɔ afã abien na wɔayɛ wɔn CT mfonini a ɛyɛ fɛ ne ahurututu mu dwumadi ho nhwehwɛmu a ɛfata koraa nkutoo na wosusuw ho da sɛ oduruyɛfo a ɔhwɛ nsu ase asuguare betumi agye wɔn afi hɔ.

Dɛn nti na me koko mu yaw a ano yɛ nnam no fii ase yɛɛ me yiye da a ɛto so abien no ɛmfa ho mpo sɛ oduruyɛfo no kae sɛ m’ahurututu da so ara abubu no?¶

Sɛ mframa di kan tu kɔ ahurututu no mu na ɛyi ahurututu no fi koko no fasu no ho a, ɛtrɛw na ɛhyɛ ɛyaw nhama a ɛwɔ akyi berɛmo no mu no abufuw, na ɛde ɛyaw a emu yɛ den a ɛyɛ sekan ba bere biara a wɔhome no. Sɛ ahurututu no mu mframa fi mu wie ma ɛyɛ nea ɛyɛ den wɔ nnɔnhwerew 12 kosi 24 akyi a, tetew ne nhyɛso a ɛyɛ nnam no gyae, enti ɛyaw a ano yɛ den no taa fi hɔ ma ɛbɛyɛ ɛyaw a ɛyɛ mmerɛw anaasɛ ɛyɛ den kakra ɛwom mpo sɛ ahurututu no da so ara bubu ɔha biara mu nkyem 30 kosi 60 de. Mfa no da sɛ ahurututu a abubu no asa esiane sɛ ɛyaw a edi kan a wɔde sekan bɔɔ no no ano abrɛ ase nti.

Dɛn ne catamenial pneumothorax na dɛn nti na ɛba bere a obi rekɔ brayɛ mu?¶

Catamenial pneumothorax yɛ ahurututu a ɛsan bubu a ɛba mmea a wɔadi mfe a wobetumi awo mu wɔ nnɔnhwerew 24 ansa na wɔafi wɔn brayɛ ase kosi nnɔnhwerew 72 akyi, na ɛka ahurututu nifa no wɔ bɛboro ɔha biara mu nkyem 90 mu. Ɛnam thoracic endometriosis (baabi a wɔde awotwaa mu ntini nketenkete a wɔde hyɛ awotwaa no mu a wɔde hyɛ nifa so ne visceral pleura) a wɔde awo mu ntokuru nketenkete (fenestrations) a ɛwɔ ahurututu no mu a ɛma mframa ne awotwaa mu ntini kɔ koko no mu bere a obi rekɔ brayɛ mu no na ɛde ba. Ɛsɛ sɛ ɔbea biara a ɔte ne koko mu yaw anaasɛ n’ahurututu a abubu wɔ ne brayɛ ho hyia no bɔ n’ahurututu ho oduruyɛfo ne mmea ho oduruyɛfo amanneɛ ma enti VATS diaphragmatic repair ne hormonal therapy a wɔde wɔn ani asi so no betumi asiw ɔsram biara a ɛbɛsan aba no ano.

So ahurututu mu yare a ɛba ara kwa no hwehwɛ sɛ wɔyɛ koko mu afiri a ɛyɛ yaw bere nyinaa?¶

Dabi Nnɛyi nnuruyɛ mu sɔhwɛ ahorow ne 2023 British Thoracic Society akwankyerɛ ahorow kyerɛ sɛ sɛ woyɛ abofra, sɛ ɛnte saa a, wowɔ apɔwmuden (Primary Spontaneous Pneumothorax), na wuntumi home kɛse a, mpɛn pii no wobetumi adi w’ahurututu a abubu no ho dwuma wɔ ɔkwan a ɛyɛ katee so denam hwɛ ne oxygen a ɛsen kɛse nkutoo so a wonni ade anaa afiri biara. Sɛ ɛho hia sɛ wɔma nsu fi mu mpo a, nnuruyɛfo a wɔwɔ hɔ nnɛ de ade a wɔde twe ade ntɛmntɛm, afiri a wɔde nantew a ɛkɔ ɔkwan biako so a wotumi hyɛ a wotumi hyɛ a ɛma wotumi kɔ fie da koro no ara, anaasɛ afiri a ɛyɛ mmerɛw a ɛyɛ mmerɛw te sɛ pɛnsere (Franse kasa 8 kosi 14) a wɔde gu mpɔtam hɔ nnuru a ɛma obi ho tɔ no ase sen sɛ wɔde bɛhyɛ oprehyɛn afiri kɛse bi ase.

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Saa akwankyerɛ yi de nkyerɛkyerɛ ho nsɛm a egye ntɛmpɛ ma na ɛnsi ayaresa a wɔyɛ adwumaden anaa nhwehwɛmu a wɔyɛ no ananmu. Esiane sɛ koko mu yaw a emu yɛ den ne ɔhome mu haw betumi akɔ anim ntɛmntɛm akodu ahodwiriw a ɛde nkwa to asiane mu anaasɛ koma a ɛyɛ den nti, yɛhyɛ nyansa denneennen sɛ fa nsaanodwuma a edi kan ne CPR adesua a wɔagye atom a efi Red Cross, St John Ambulance, anaa mpɔtam hɔ ntetee a egye ntɛmpɛ a wɔagye atom.

Akwankyerɛ ahorow a ɛfa ho¶

• Tension pneumothorax ne nufu koko mu kuru mmoa a edi kan
• Flail chest, mpampam a abubu, ne blunt thoracic trauma
• Ahurututu mu ntini a ɛma mogya tu ne ntini a emu dɔ a ɛma mogya tu (DVT) .
• Pericarditis, myocarditis, ne ɔyare mmoawa akyi koko mu yaw frankaa kɔkɔɔ
• Asthma ntua mmoa a edi kan a egye ntɛmpɛ

Fibea ne aban akwankyerɛ¶

• British Thoracic Society (BTS, United Kingdom): British Thoracic Society Guideline for Pleural Disease (2023): Adanse a egyina protocols so ma conservative management, ambulatory pleural vents, needle aspiration, Seldinger chest drainage, VATS pleurodesis, wimhyɛn akwantuo twɛn berɛ, ne diving anohyetoɔ.
• European Respiratory Society (ERS): ERS Adwumakuo Asɛm a ɛfa Primary Spontaneous Pneumothorax ho: Nhwehwɛmu ne Nneɛma a Edi Kan ne Nea Ɛsan Ba ​​Ho Nhwehwɛmu.
• Amerika Ahurututu Fekuw (ATS) ne Amerika Koko Nnuruyɛfo Kuw (CHEST, United States): Ahurututu mu Ahurututu a Ɛwɔ Ahurututu mu Nnuruyɛfo a Wɔhwɛ So a Wɔpene Asɛm ne New England Journal of Medicine Conservative versus Interventional Treatment for Primary Spontaneous Pneumothorax Trial (Brown ne afoforo, ANZ).
• Ahunmu Aduruyɛ Fekuo (AsMA) ne Amanaman Ntam Wimhyɛn akwantuo Fekuo (IATA): Aduruyɛ Akwankyerɛ a Ɛfa Wimhyɛn Akwantuo Ho: Ɔhome mu Ahoɔden a Wɔde Tu Wimhyɛn Wɔ Pneumothorax ne Thoracic Oprehyɛn akyi.
• Prehospital Trauma Life Support (PHTLS) ne Amerika Koma Fekuw (AHA): Advanced Koma ne Ntini mu Nkwa Mmoa (ACLS) Hu ne Decompression a ɛfa Obstructive Shock a efi Tension Pneumothorax mu.