Pneumothorax gonɗo e hoore mum, maale ɓuuɓɗe ɓuuɓɗe, e ɓuuɓri ɓalndu pleuritik¶

Pneumothorax spontané (ko heewi wiyeede ko ɓuuɓri ɓuuɓndi) ina waɗa so henndu yaltii e ƴiiƴam ɓuuɓɗam, ɗam fawi e nder weeyo pleural, woni ɓuuɓri ɓuuɓndi ndi ndiyam ɓuuɓɗam woni hakkunde yaasi ɓuuɓri ndii e nder ɓalndu nduu. Nanduɗo e ɓuuɓri ɓuuɓndi ndi a... ɓuuɓri ɓalndu walla ɓuuɓri ɓalndu ɓuuɓndu walla a gaañannde naatnde e ɓernde, pneumothorax spontané ina fiyra ɗoon e ɗoon e fooftere tawa alaa ko battini e ɓanndu. Ina addana neɗɗo ɓuuɓde, ɓuuɓnde, ɓuuɓnde, ɓuuɓnde, ɓuuɓnde, ɓuuɓnde, ɓuuɓnde, ɓuuɓnde, nde ɓeydotoo kala fooftere (ɓuuɓri ɓuuɓndi pleuritik) e ɓuuɓde foofaango no feewi. So a sikkii ɓuuɓri ɓuuɓndi, noddu limoore emergency nokku maa e laawol amen limooje caɗtuɗe directory ɗoon e ɗoon e jogaade neɗɗo oo jooɗiiɗo ina tiiɗi, ina timma, no kala ɓuuɓri ɓuuɓndi ina waawi bonnude haa wonta pneumothorax tension gonɗo e nguurndam walla mimic a ɓuuɓri ƴiiƴam walla ɓuuɓri ɓernde.

Waɗde ɗum jooni¶

1. Noddu limngal emergency nokkuure ma law law: Noddu 911 haa lesdi Amerika e Kanadaa, 112 nder Dental Orop, 999 haa lesdi Biritaniya, 000 haa Ostarali, malla laaru limngal men hakkunde lesdi limooje caɗtuɗe doggol. Haaldu e diisneteeɗo oo wonde ñawɗo oo ina wondi e muus reedu ɓuuɓndu, ɓuuɓndu, ɓuuɓndu, ɓuuɓndu, ɓuuɓndu, ɓuuɓndu, ɓuuɓndu, tawa ina tuuma ɓuuɓde (pneumothorax).
2. Waɗde neɗɗo oo e nokku jooɗiiɗo moƴƴo, tiiɗɗo walla semi-tiimɗo (fowler) walla ŋoŋɗi seeɗa e bannge muusɗo: Joɗnde tiiɗnde e ŋorol 45 haa 90 degere ina fooɗa terɗe reedu les e semmbe, ina rokka expmm lung maxian mo mettinaani. Hoto meeɗ doole ñawɗo ɓuuɓɗo ɓernde mo foofaani, yoo lelnu e dow koyɗe mum.
3. Woppu kala ko ina addana ɓanndu, yahde, ɓuuɓde, walla ɓuuɓde (manouvres de Valsalva): Hoto ɗaccu neɗɗo oo ina jippoo e les njiimaandi mum haa to ambulance, ina jogoo saakuuji, ina ƴetta geɗe, walla ina fuɗa nofru mum e doole. Kala foofaango doole, ɓuuɓri, walla ɓuuɓri Valsalva ina addana henndu ɓurndu heewde rewrude e ɓuuɓri pleural ruppitiiɗo e nder ɓalndu, ina yaawi ɓuuɓde ɓuuɓri.
4. Loowde comci tiiɗɗi e saraaji ɓalndu, daande, e koyɗe e deeƴnude foofaango maɓɓe: Ƴettu kolce, loowde ɓoggi walla brasuuji tiiɗɗi, e coftal foofaango leelngo, ɓuuɓngo, deeƴngo. Gaasgol luggiɗngol ngol kulhuli addata ina ɓeyda ɓuuɓri ƴiiƴam, ina ɓeyda kadi mette ɓuuɓɗe.
5. Waɗde oksijen ɓeydiiɗo toowɗo so tawii ko jannginaaɗo e kaɓirɗe: So tawii siliñ oksijen ɓuuɓɗo mo mask mo alaa fooftere ina woodi e nokku gollorɗo, laana ndiwoowa, walla kilinik, waɗde oksijen toowɗo e **10 haa 15 liiteer se ɓuuɓri oksijen 88 haa 92 e nder teemedere haa safrooɓe ngarta e ƴeewndo gaas ƴiiƴam). Oksijen toowɗo ina feewna oksijen gonɗo e nder ƴiiƴam (hipoxemie) ina yaawi kadi ɓuuɓnude azot pleural nanngaaɗo oo fotde laabi nay.
6. Ƴeewto ko juuti banngeeji boɗeeji Tension Pneumothorax: Ƴeewto wutte neɗɗo oo, leppi mum, ƴiiƴam mum, e hakkille mum kala hojomaaji 2. So tawii ɗe ngontii siyanotik (leppi daneeji) no feewi, ɗe njiiɓii, ɗe ɓuuɓtii, ɗe ɓuuɓtii, ɗe ɓuuɓtii, ɗe ɓuuɓtii, walla ɗe ɓuuɓtii, walla ɗe ɓuuɓtii ƴiye wuddu, mbiyaa ɗoon e ɗoon nelooɓe emergency wonde ñawɗo oo ina bonna, ina sikkaa ina wondi e tension pneumothorax, ina ɗaɓɓi decompression needle paramedic ɗoon e ɗoon.
7. Haɗeede kala yah-ngartaa weeyo, telefoŋaaji dow koye, e diwgol e nder ndiyam: Hay so tawii nafoore ɓernde ina nanndi e ɓuuɓri e ɓuuɓri, neɗɗo mo pneumothorax mo safraaka walla mo sellaani, fotaani meeɗde naatde e laana ndiwoowa, yahde e dow ŋoral toowngal dow koɗli, walla naatde e ndiyam ngam diwde, as pressured Bo'an will henndu ɓernde nanngaandu e saabaade ɓuuɓri ɓernde e ƴiiƴam.

Lekki kuulal : Ɓooygol ɓalndu pleuritis bannge gooto e triage pneumothorax¶

flowchart TD
    Start["Naafigaagal ɓernde bannge gooto (ɓuri bonde e fooftere) e ɓuuɓri foofaango (alaa ko bonnata ɓernde)"] --> TensionCheck{"Mbele WONI Banndiraagal Boɗewal Pneumotorax Tension? 1. Heege henndu mawndu walla waasde haalde 2. Leppi daneeji (cyanosis), SpO2 les 90% 3. Pulse jaawɗo leelɗo (ko ɓuri 120 bpm), hipotension, walla sinkope 4. Ɓowɗi wuddu ɓuuɓɗi walla ɓuuɓri henndu ɓuuɓndi 5. Ñawɗo oo ina jogii ventilaasiyoŋ ko wayi no COPD, sever-"}

    TensionCheck -->|"EEY: Kuutoragol Nguurndam ɗoon e ɗoon"| TensionProtocol["PNEUMOTORAKS TENSION WALLA PNEUMOTORAKS SPONTANE ƊIƊAƁOL: 1. Noddu 911 / 112 / 999 STAT e bayyinde Pneumothorax Tuumaaɗo 2. Waɗde ñawɗo oo ina jooɗii ina tiiɗi (45 haa 90 degereeji toowɗi O20) 15 L/min e laawol non-rebreather ; 88 haa 92% target so tawii ko COPD tiiɗɗo) 4. WOTO MEƊƊU waɗde CPAP, BiPAP, walla ɓuuɓri saak-valve-mask doole hade ɓuuɓri ɓalndu 5. Torakostomi njuumri ɗoon e ɗoon rewi heen ko naatgol tuuba ɓalndu e nder safrirde"]

    TensionCheck -->|"NO: Hemodinamik dariiɗo, haaloowo konnguɗi timmuɗi, pulse no woorunoo"| RiskProfile{"Ƴeewtaade mbaydi ñawɗo oo : Ɓooyɗo (PSP) vs Ɗiɗaɓo (SSP) e Katameniyal"}

    RiskProfile -->|"Suka (15 haa 35 yrs), juutɗo/sewɗo, simme/vaper, alaa ñawu ɓuuɓngu ko adii"| PSP["Pneumothorax spontané primaire (PSP) tuumaama : ɓuuɓri gonndi e ɓalndu (bleb) ɓuuɓndi"]
    RiskProfile -->|"Duuɓi ko ɓuri duuɓi 50, WALLA daartol COPD, emfisema, asma, fibrose cystique, Marfan"| SSP["Pneumothorax spontané secondaire tuumaaɗo (SSP) : Rezerw pulmonaire les e baasal mawngal e dekompensaasiyoŋ jaawɗo"]
    RiskProfile -->|"Ina waɗa e nder waktuuji 72 hade walla caggal nde lewru fuɗɗii"| Catamenial["Endometriose katameniyal / torasik tuumaaɗo Pneumotoraks : Ko ɓuri heewde ko bannge ñaamo (ko ɓuri 90%)"]

    PSP --> HospitalEval["Jaɓɓugol e nokku jooɗiiɗo to opitaal ED (WOTO yahdu walla eɓɓoore): Tabitin mawneeki rewrude e X-Ray ɓernde ɓuuɓnde, Ultrasound ɓernde (sliding pulmonaire mo alaa), walla CT"]
    SSP --> HospitalEval
    Catamenial --> HospitalEval

    HospitalEval --> SizeBranch{"Triage opitaal e mawneeki e maale (Laabi BTS / ATS / ERS)"}

    SizeBranch -->|"PSP tokooso (les 2 cm rim to hilum) E fooftere seeɗa walla alaa"| Conservative["Lartol Konservatiif + Terapi Oksijen toowɗo : Reabsorbs e 1,25% haa 2% e ñalawma (4x ɓuri yaawde e O2 toowɗo) Fuɗɗito-ɗaa e nder waktuuji 4 haa 6, caggal ɗuum rewindaade e nder safrirde tawa ina waɗi kuulal tiiɗngal NO FLYING"]
    SizeBranch -->|"PSP mawɗo (rim 2 cm walla ɓurɗo mawnude) WALLA mo foofaani WALLA kala Pneumothorax ɗiɗaɓo (SSP)"| Intervention["Dekompresiyoŋ pleural kuuɓtodinɗo : - Aspiraasiyoŋ ɓuuɓɗo (kanula 14G haa 16G) WALLA kuutorgal ɓuuɓngal Heimlich - Tuubaako Seldinger ɓuuɓɗo (8 haa 14 Fr) jokkondirɗo e ɓuuɓol les ndiyam - Pleurodesis VATS so tawii ko ɓuuɓol henndu toowngol jokki (over, walla3"]

Patofisiyoloji : No ɓuuɓri ɓuuɓtortoo tawa alaa ko bonnata ɓernde¶

E nder ɓalndu cellundu, ɓalndu yaajndu (pleura viscérale) e ɓalndu nder ɓalndu (pleura pariétale) ina njillondiri e dow ɓuuɓri ɓuuɓri ɓuuɓri (10 haa 20 mililiter [0,3 haa 0,7 ons ndiyam]). Sabu ɓuuɓri elastik ina rewindaa e nder mum tawa ko e nder mum, tawi noon ɓuuɓri ndii ina ɓuuɓtoo caggal, nokku hakkunde ɗeeɗoo ɓuuɓri ɗiɗi ina jogoo ɓurɗo famɗude e nder weeyo (negatif) intrapleural -3 haa -5 cmH2O e fooftere, ina ustoo haa -8 haa -10 cmH2O e nder fooftere luggiɗnde. Ngolɗoo suukara ɓuuɓɗo ina addana saakuuji henndu (alveoli) ɓuuɓde e ƴiye.

1. Ɓoornugol apikal, bullaaji, e majjugol suukara pleural bonɗo¶

Saakuuji henndu tokoosi nannduɗi e ɓuuɓri ina wiyee ɓuuɓri subpleural (les santimeeteer 1 haa 2 [0,4 haa 0,8 inch] njaajeendi, e nder ɓuuɓri ɓalndu) walla ɓurndi mawnude bullaaji emfisematooji (ko ɓuri santimeeteeruuji 1 haa 2 ƴellitooji e destroolarye) (apex) e ɓuuɓri ɓuuɓri toowndi.

Teddeendi ina fooɗa ɓuuɓri teddundi ndii les, feewde e ɓuuɓri ndii. E neɗɗo mo ɓuuɓri ɓalndu juutndi, ɓuuɓndi (maandi ektomorfik), tooweeki gonndi e ɓalndu ina addana ɓuuɓri ɓuuɓri pleural (0,25 cmH2O e santimeeteer toowgol ɓuuɓri). Alveoli gonɗi dow ɗii ina keɓa semmbe ɓurɗo semmbe e alveoli gonɗi les ɗii, ina ɓuuɓna ƴiiƴam apikal haa ɓuuɓri subpleural ɓuuɓndi feeña.

So ɓuuɓri apikal ruppitiima e nder ƴiiƴam ɓalndu, uddital waɗata hakkunde laabi henndu e ɓuuɓri ƴiiƴam gonndi e ɓuuɓri : 1. Henndu ina doga e ɓuuɓri ina naata e nder weeyo pleural haa ɓuuɓol ngol majja, ɓuuɓol nder ɓuuɓol ngol fotnda e ɓuuɓol weeyo (0 cmH2O). 2. So ɗum ɓoornaama wutte mum yaajɗo, ɓuuɓri elastik ina rewi e nder mum feewde e ɗaɗol mum hakkundeewol (hilum), ina ɓuuɓtoo seeɗa walla haa laaɓa. 3. Ɓoornugol ɓuuɓngol ngol ina woppa tawtoreede mbayliigu gaas, ina addana mbaylagol ventilaasiyoŋ-perfusion (V/Q) e ɓuuɓgol ñaamo-naamo haa vasoconstriction pulmonaire hypoxique rewna ƴiiƴam e ɓuuɓol cellungol.

2. Ko waɗi oksijen toowɗo ina yaawi ɓuuɓde fotde 400 e nder teemedere (Nitrogen Washout)¶

Ko ina wona 78 e nder teemedere gaas pleural nanngaaɗo ina waɗi azot (N2), gaas mo alaa ko waawi, mo ɓuuɓnataa no feewi e nder ƴiiƴam. E nder fooftere suudu no woorunoo, pneumothorax udditiiɗo e hoore mum ina rewta e nder kapilaaruuji pleural e 1,25 haa 2,2% tan e njuuteendi hemithorax e nder waktuuji 24 (ɗum firti ko 30% e ɓuuɓri ina ƴetta jonte 2 haa 3 ngam laaɓtude e hoore mum).

So safrooɓe walla safrooɓe urgence mbaɗii oksijen ɓeydiiɗo toowɗo (10 haa 15 liiteer e nder hojomaaji 10 rewrude e mask mo foofaani), oksijen ɓuuɓɗo oo ina loota azot e nder ƴiiƴam cirƴam, ina ustoo feccere e ɓuuɓri azot e nder kapilaaruuji pleural ɗii gila e ko ina tolnoo e mmH35 e ƴiye. Ɗum ina addana diffusion de pression partielle ɓuuɓɗo hakkunde poos pleural keewɗo azot e ƴiiƴam kapilaar mo azot mum famɗi, ina yaltina gaasuuji nanngaaɗi e nder nokku pleural laabi nay ɓurɗi yaawde (fotde 4 haa 8 e nder teemedere e ɓuuɓri hemithorax e ñalawma).

Yerondirde e sifaaji nay kilinik pneumothorax spontané¶

Faamde hol cate ñawɗo fawii e guides triage, sibu suka atletee celluɗo mo 25% e ɓuuɓri ina waawi feeñde e fooftere, tawi noon suka jahroowo e duuɓi 65 mo emfisema e 10% e ɓuuɓri ina waawi yaawde heɓde hipoksiik.

Anndude maale : Kollirgol ngol aldaa e caɗeele vs¶

1. Maandeeji kiiɗɗi ɗi pneumotorax gonɗo e hoore mum¶

E nder ko ɓuri 80 e nder teemedere, pneumothorax spontané primaire ina waɗa e fooftere wonaa e sahaa ekkorse teeŋtuɗo : - Naafigaagal ɓalndu gootol, ɓuuɓngal, ɓuuɓngal, ɓuuɓngal (Pleuritic Pain) : Ƴettude fooftere luggiɗnde, ɓuuɓde, jaleeɗe, walla ɓuuɓnude ɓalndu ina addana neɗɗo nanngugol tiiɗngol, doole fooftere juutnde, ɓuuɓnde ("splinting"). - Nafoore ipsilateral to bannge ɓalndu walla to bannge ɓalndu toowndu (scapular) : Sabu pleura parietal ina sudda ɓalndu hakkundeeru ina ɓuuɓna nerve frenique (daɗe ɓalndu C3, C4, e C5), ɓuuɓri ummoraade e henndu dogdu ina jokkondiri e dow ɓalndu si de e dow sa. - Ɓooygol fooftere (Dyspnée): Ina ummoo e heege henndu seeɗa e dow ŋoral haa e mette ɓuuɓɗe e fooftere. - Kosam yoorɗam, hacking, mo alaa ko nafata : Ko ɗum ummotoo ko e ɓuuɓri pleura nde ɓuuɓri ndii ɓuuɓnata. - Emfisema les ɓalndu ("Rice Krispies" ina ɓuuɓtoo les ɓalndu) : Henndu rewindaade e nder ɓalndu (pneumomediastinum) e wuddu ina addana ɓuuɓri les koppi walla daande ɓuuɓnde e ɓuuɓri ɓernde (maande Hamman). - Ko yiytaa e ƴeewndo ɓanndu : Bannge mo ñawu nguu heɓtii oo ina famɗi diwde e fooftere, ina nanndi e ɓuuɓri so tappiima (hyperresonance to percussion), ina jogii sonnde foofaango ustaare walla alaa e auscultation.

2. Yahrude yeeso e pneumotorax tension : Emergency valve laawol gootol¶

Pneumothorax tension ina waɗa so ƴiiƴam ɗam ɓuuɓɗam ɗam waɗii valve laawol gootol : fooftere ina sooma henndu yaltundu e lekki bronchial e nder ɓuuɓri pleural, kono fooftere ina siimta flap oo haa henndu waawa yaltude.

Kala fooftere, ɓuuɓol moƴƴol ina maha e nder ɓalndu (+10 haa +20 cmH2O walla ko ɓuri ɗum) : 1. Kollas ɓuuɓɗo ipsilateral timmuɗo : ɓuuɓɗo mo ñawu nguu heɓtii oo ina ɓuuɓtoo e dow hilum. 2. Shift mediastinal e compression de la pulmon opposé : Ɓooygol ɓeydotoongol ina ɓuuɓna ɓernde, ƴiiƴam (trachée), e ƴiiƴam mawɗam e nder laylaytol hakkundeewol ngol, naata e bannge celluɗo oo, ina ɓuuɓna ƴiiƴam heddiiɗam ɗam. 3. Kinking Vena Cava e Shock Obstructive : Ɓooygol moƴƴol nder reedu ina ɓuuɓna vena cava toowɗo e les ina uddita. Gartugol ƴiiƴam to atrium ñaamo ina ustoo haa zero, yaltugol ɓernde ina ustoo e nder shock obstructive, ñawɗo oo ina heɓa Arrêt cardiaque pulseless activity électrique (PEA) e nder hojomaaji seeɗa so wonaa tawa ko e decompression de couche walla e tuubaaji ɓalndu.

Seerndude Pneumotorax Simple e Pneumotorax Tension to bannge leeso¶

Ñawbuuli ceertuɗi : Sabaabuuji goɗɗi gonɗi e ɓuuɓri ɓalndu pleuritis¶

Paramedics e cafrooɓe emergency ina ƴeewtoo e nder njuɓɓudi emergency ɓernde gonnde e dow mum:

1. Embolism ɓuuɓɗo (PE): Ƴiiƴam ɓuuɓɗam ummoraade e ƴiiƴam luggiɗam (DVT) feewde e ƴiiƴam ɓuuɓɗam ina addana neɗɗo ɓuuɓri ɓalndu pleuritik, ɓuuɓri ƴiiƴam, e takikardiya. Nanduɗo e pneumothorax, daande foofaango ina foti banngeeji ɗiɗi ɗii fof, ñawɓe ina mbaawi ɓuuɓde ƴiiƴam (hemoptisis), e geɗe baawɗe addande ɗum ñawu nguu, ina jeyaa heen seppooji baɗanooɗi ko ɓooyaani, diwde juutnde, waasde yahde, reedu, walla kanseer.
2. Perikarditis ɓuuɓɗo e Miokarditis: Ina addana ɓuuɓri ɓalndu pleuritik hakkundeeri walla nano ɓuuɓndi, ɓuuɓndi haa e ŋoral trapezius ngal ɓurtata bonde so neɗɗo ina lelni, ina moƴƴi so ina jooɗii ina ŋoŋɗi yeeso, tawa ina waɗi daande fooftere ɗiɗmere no woorunoo.
3. Ɓernde Ɓooynde e Diisnondiral Aorta: Infarc miocardique ina addana ɓuuɓri retrosternal teeŋtundi, tawi noon ɓuuɓri aorta ina addana ɓuuɓri ɓuuɓndi ɓuuɓndi, ɓuuɓndi haa ɓalli (ina tiiɗi ngam ittude e sindrom Marfan, ko ɗum addanta ɓuuɓri pneumothorax e ɓuuɓri aorta).
4. Rupture esophagique (Syndrome de Boerhaave) : ko gonɗi gonɗi e nder ɓalndu caggal nde neɗɗo ɓuuɓti e doole, ina yaltina asid gastriik e henndu e nder ɓalndu e nder ɓalndu nano.

Toppitagol hade safrirde e safrirde : Ko foti wonde e safrooɓe e ED¶

1. Ko waɗi ɓuuɓri gonndi e ɓuuɓri (CPAP, BiPAP, walla BVM) ina bonna hade ɓuuɓri¶

So tawii ñawɗo mo pneumotorax mo anndaaka ina wondi e foofaango, waɗde CPAP, BiPAP, walla ventilaasiyoŋ doole bag-valve-mask (BVM) ina pompa henndu ɓuuɓndu rewrude e gonɗi pleural e nder ɓuuɓri ɓalndu, ina wayla ɓuuɓol koyngol ngol wonta pneumotorax tension fatal. Jaabtiiɓe ɓee ina njuurnitoo sahaa kala ɓuuɓri ndii fof (e huutoraade ultrasound to bannge leeso) hade mum en waɗde ɓuuɓri moƴƴiri e laawol henndu.

2. Ñawndugol safrirde : Rajo-X ɓalndu tiiɗndu e Ultrason ɓalndu (POCUS)¶

• Rajo-X ɓalndu Posteroanterior (PA) tiimɗo: Ina hollita doggol danewol tiiɗngol (edge pleural visceral) tawa ina waɗi maandeeji ɓuuɓɗi ɗi ngalaa e saraaji doggol ngol. Filmuuji fooftere ruttiiɗi ngalaa haaju.
• Ultrason toraks toɓɓere toppitiinde (POCUS) : Ina yiytoo pneumotorax e nder leƴƴanɗe 30 tawa ina ɓuri ɓuuɓde e radiyoo gonɗo e dow ŋoral. Fuuɗngo ɓuuɓngo ina hollita alaa ɓuuɓol ɓuuɓol, ŋakkeende laabi B wutte koode, kodde barre "maande stratosfeer" e dow M-mode, e "toɓɓere ɓuuɓol" ƴeewndo.

3. Cuɓe safaara jamaanu : ƴeewndo, aspiraasiyoŋ, tuubaaji ɓernde, e VATS¶

E tuugnaade e 2023 Fedde Angalteer (BTS) ngam haɓaade ñawu nguu e jarribooji winndereeji :

1. Njuɓɓudi gonndi e ɓuuɓri (Ƴeewndo tan): Wonande sukaaɓe, celluɓe wonduɓe e Pneumothorax Spontaneous Primary (PSP) ɓe ɓurti famɗude walla ɓe ngalaa foofaango e nguurndam dartiiɗam, ƴeewndo e oksijen toowɗo e rewtin'de tear X-ray e nder waktuuji 4 ina addana ɓe waawde heɓde tu.
2. Aspiraasiyoŋ ɓuuɓɗo walla Valve Heimlich Ambulatoire: Wonande ñawɓe PSP ɓe foofaani, safrooɓe ina mbaawi aspiraasiyoŋ henndu e kanel 14G haa 16G (fotde 2,5 liiteer [2,6 liiteer]) walla waɗde **valve pleural ambulatoire mo hoore mum woni e mum ngam **aspiration pleural oneway (8 F-im) yaajde e nder balɗe 2 haa 4.
3. Ɓuuɓri ɓalndu Seldinger tokosiri (8 Fr haa 14 Fr): So tawii ko pneumotorax ɗiɗaɓo (SSP), aspiraasiyoŋ mo ŋakkaani, walla ɓuuɓri mawndi, safrooɓe ina mbaɗa 8 haa 14 kateter Seldinger Farayse e les anestesi nokkuyankeewo pectoralis mawɗo, latissimus dorsi, nokku 5ɓo hakkunde ƴiye, e aksilla), jokkondirɗo e butelaaji ɓuuɓɗi les ndiyam.
4. Dekompression (Toracostomie): Ngam pneumotorax tension e soklaaji, safrooɓe ina mbaɗa kanel mawɗo (14G, njuuteendi mum ko 4,5 haa 8 santimeeteer [1,75 haa 3,25 inch]) e nder 2^nd intercostal spaceth or5d anterior to ligne midaxillaire** (dow tan e daande ɓalndu toowndu), ɓuuɓna ɓuuɓol nanngaangol ɗoon e ɗoon.
5. Haɓde e ɓuuɓri (Bullectomie e Pleurodesis VATS): Ngam ɓuuɓri henndu duumiindi (ko ɓuri balɗe 3 haa 5), ɓuuɓri ɓuuɓri, walla golle ɓurɗe heewde baasal (piloteeɓe, diƴƴe), Opereeji apiktoomi e ballitooji wideyoo (VATS) pleura rewrude e abrasion, pleurectomie, walla talc poudrage, ustude ɓuuɓri gila e 30 haa 50 e nder teemedere haa 1 haa 5 e nder teemedere.

Toowgol, yah-ngartaa e weeyo, diwgol e nder ndiyam, e reentaade caggal nde neɗɗo selli¶

So pneumothorax spontané sellii, ñawɗo oo yaltinaa galle, kuule barometrik e nguurndam tiiɗɗe ina ndeena ɗum e ɓuuɓri potndi warde :

• Kuulal ɗaɓɓugol yah-ngartaa weeyo njulaagu (Fedde safaara BTS & Aerospace):
• A fotaani MEƊƊE fiyde e pneumothorax gonɗo e golle, heddii, walla mo safraaka e kala mawneeki.
• So tawii ƴeewndo ɓalndu caggal safaara ina hollita 100 e nder teemedere ƴeewndo radiyoo timmungo (ɓuuɓri ndii ina yaaji haa timmi e dow ɓalndu nduu tawa alaa ko heddii e poosi henndu), Fedde Toraasiyoŋ Angalteer ina wasiyoo nde rewata ko famɗi fof balɗe 7 timmuɗe caggal ƴeewndo ngoo no woorunoo (e heewɓe e Medical Aerospace re.com balɗe 14 caggal ƴeewndo radiyoo timmungo) hade mum naatde e laana ndiwoowa njulaagu, ngam hoolkisaade so tawii ɓuuɓri pleural visceral fragile ndii udditataa so tawii ɓuuɓri kabine ina ustoo to tooweeki.
• Haɗeede diwgol ndiyam duumingol:
• Sabu ƴeeŋtude e hay piscine 10 meeteruuji (33-foot) ɓuuɓɗo walla diwde e nder geec ina ɓeyda laabi ɗiɗi njuuteendi kala gaas nanngaaɗo, ina waawi kadi saabaade barotrauma pulmonaire e embolisme gaz artérielle (AGE) waɗii pleurectomie chirurgicale bilatérale, o waɗii CT keeriiɗo toowɗo e ƴeewndo golle pulmonaire e karallo ko faati e safaara diving.
• Woppu Simmeeji e Vaping haa timma:
• Jokkude ɓuuɓde simme tuubaako, jokkondire/bonguuji ganndal (ko ɗum waɗi fooftere luggiɗnde e manndaaji Valsalva juutɗi jogaade foofaango), walla simmeeji/vapeeji elektoronik ko huunde wootere ɓurnde mawnude e waylude mbayliigu. Woppude cumu e nguleeki fof ina usta baasal ɓuuɓri ɗiɗmiri gila e ko ɓuri 40 haa 50 e nder teemedere haa e ko ina tolnoo e 15 haa 20 e nder teemedere.
• Reento Ɓooygol Teddungol, Kuutorɗe Henndu, e Pijirlooji Jokkondirɗi fotde Yontereeji 2 haa 4:
• Waɗde, ɗaɓɓu haa cellal radiyoo timmungal e laaɓal ummoraade e pulmonologist maa hade maa hootde e ƴettugol teddeendi teeŋtundi (reenaade ƴettugol Valsalva jogorngol foofaango), fiyde kuutorɗe njamndi walla leɗɗe toowɗe, walla tawtoreede dingiral jokkondirngal.

Limooje emergency diiwaan e porotokolle agence¶

• Leyɗeele dentuɗe Amerik e Kanadaa: Noddu 911 ɗoon e ɗoon ngam heɓde ɓuuɓri pleuritic e ɓuuɓri fooftere. Safrooɓe ko adii opitaal ina njokki e Fedde Ameriknaare Ɓernde (AHA) e Ballal Nguurndam Ko adii Opitaal (PHTLS) / Fedde Ngenndiije Dentuɗe ngam Safrooɓe EMS (NAEMSP) porotokolle ngam ƴellitde oksijen toowɗo, oksimetri pulse, e torakostomi (2^nd intercostal intercostal line5th or4d intercostal intercostal or5d) laylaytol aksilaar yeesowol) so tawii fisiyoloji tension ina ƴellitoo. Njuɓɓudi opitaal ina rewi laawol Fedde Ameriknaare Toraas (ATS) e Koldaa Ameriknaajo Cafrooɓe Toraas (CHEST).
• Dental Dowlaaji Dentuɗi: Noddu 999 ngam heɓde ambulance (nafoore ɓuuɓnde e ɓuuɓri fooftere ko noddaango 999 sahaa kala). Toppitagol safrirde ina rewi e Laabi 2023 Fedde Toraasiyoŋ Angalteer (BTS) 2023 ngam Ñawu Pleural e NICE, jowitiiɗi e njuɓɓudi konservatiif, ɓuuɓri pleural ambulatoire ambulatoire, e ɓuuɓri ɓalndu Seldinger tokosiri.
• Dental Orop: Noddu 112 e nder leyɗeele jeyaaɗe e UE ɗee kala. Kippuuji opitaal ina njokki e Fedde Oropnaare Fooftere (ERS) laabi gollorɗi safaara ngam pneumothorax spontané primaire e secondaire, kuutortooɗi ultrasound thoracique sara leeso, systems de drainage thoracique numérique, e konsultaasiyoŋ VATS ko adii.
• Ostraali e Nuwel Selannde: Noddu 000 to Ostarali walla 111 to Nuwel Selannde. Sarwisaaji ambulance e departemaaji emergency ina njokki e Fedde Toraas Ostarali e Nuwel Selannde (TSANZ) e Goomu Ostarali e Nuwel Selannde ngam wuurtinde (ANZCOR) laabi, ina naatna heen humpitooji ummoraade e ñaawoore PSP ANZ mawnde, nde nokkuuji keewɗi e nder nokkuuji keewɗi.
• Inndo e Asii-Pacifik: Noddu 112 to Inndo, 995 to Singapuur, 119 to Japon e Koree worgo, walla 999 to Hong Kong e Malesi. Ɗaɓɓu ambulance Advanced Life Support (ALS) jogiiɗo oksijen e humpitaade departemaa jaɓɓoowo ngam waawde feewnude radiyoogaraafi ɓalndu tiiɗndu e dekompression pleural.

Naamne keewɗe naamneede¶

Hol ko waɗi sukaaɓe worɓe juutɓe, ɓuuɓɓe, yahrooɓe e duuɓi capanɗe jeegom ina keewi ɓuuɓde e ɓuuɓde e hoore mum ?¶

E nder ɓuuɓri mawnugol sukaaɓe yaawɓe, ɓuuɓri ɓalndu toowndi, ɓuuɓndi ina waɗa ɓuuɓri gonndi e dow ɓuuɓri haa e les. Saakuuji henndu (alveoli) to dow ɓuuɓri ndii ina keɓa ɓuuɓri ɓuuɓndi ɓurndi semmbe e ɓuuɓri heddii ndii, ɗum noon ina addana ɓuuɓri tokosiri nanndundi e ɓuuɓri gonndi e dow ɓuuɓri toowndi ndii. So tawii gooto e ɗeeɗoo ɓuuɓri apikal ɓuuɓndi ɓuuɓtii (haa teeŋti noon so tawii ina leefɗi e ɓuuɓri ƴiiƴam tokosiri ummoraade e simme walla ɓuuɓri), henndu nduu ina yalta e nokku pleural mo ɓuuɓri mum tolnii e 100 000 mbuuɗu, ina ɓuuɓna ɓuuɓri ndii hay so ina jooɗii.

Hol no foti waktuuji caggal nde ɓuuɓri ɓuuɓndi selli, ina moƴƴi diwde e laana ndiwoowa njulaagu ?¶

A fotaani meeɗde naatde e laana ndiwoowa tawa kala ko heddii e pneumothorax ina woodi e radiyoo ɓalndu, sibu tolno nguleeki ɓalndu ina addana henndu ɓalndu nanndundu nduu yaajde fotde 25 haa 38 e nder teemedere. E wiyde fedde wiyeteende British Thoracic Society (BTS), aɗa foti fadde ko famɗi fof balɗe 7 timmuɗe caggal nde ƴeewndo (radio-X) rewindaade ɓalndu nduu, tawa ina hollita 100 e nder teemedere (e nder teemedere fof) pneumothorax (e ko heewi e laaɗe diwooje e Fedde safaara aerospace ina ɗaɓɓi fadde balɗe 14 caggal nde ƴeewndo radiyoo timmuɗo waɗi) hade maa fadde haa timma.

Mbele miɗo waawi diwde kadi caggal nde keɓ-mi pneumothorax e hoore am?¶

E nder Fedde Toraasiyoŋ Angalteer, Divers Alert Network (DAN), e jamirooje safaara diƴƴe winndereeje, pneumothorax gonɗo e hoore mum ko huunde nde waawataa diwde e henndu ɓuuɓndu, hay so tawii noon ko caggal nde ɓuuɓri ndii selli haa laaɓi, hay so tawii noon caggal nde talk walla pleurodesis abrasion. Waylooji ɓuuɓɗi ɓurɗi heewde e les ndiyam ina mbaawi ɓuuɓnude ɓuuɓri mikroskoop e nder ɓuuɓri kala, e yaajnude henndu nanndundu e 200 haa 400 e nder teemedere e nder weeyo, addana ɗum pneumothorax tension fatal hade mum yettaade dow ; ko kanndidaaji seeɗa tan mbaɗi pleurectomie surgical bilatéral, jogiiɗi CT scans toowɗi no feewi e ƴeewndo golle ɓuuɓɗe, meeɗi ƴeewteede ngam laaɓtinde e cafroowo diwooje.

Hol ko waɗi ɓuuɓri am tiiɗndi ndii fuɗɗii welde ñalnde ɗiɗmere ndee hay so tawii doktoor oo wiyi ɓuuɓri am ina ɓuuɓtoo haa jooni?¶

So henndu fuɗɗiima yaltude e nder ɓuuɓri ƴiiƴam, ina ɓuuɓna ƴiiƴam ɗam e nder ɓalndu, ina ɓuuɓna, ina ɓuuɓna fiɓnde ɓuuɓnde e nder ƴiiƴam parietal, ina addana ɗum ɓuuɓri ɓuuɓndi e kala foofaango. So tawii ɓuuɓri ndii gasii ɓuuɓde haa wonti darnde tiiɗnde caggal waktuuji 12 haa 24, ɓuuɓri gonndi e ɓuuɓri ndii ina jokka, ɗum noon ɓuuɓri ndii ina heewi ustaade haa wonta ɓuuɓri ɓuuɓndi walla ɓuuɓri seeɗa hay so tawii ɓuuɓri ndii ina heddii 30 haa 60 e nder teemedere ina ɓuuɓtoo. Hoto meeɗ sikkude ɓuuɓri ɓuuɓndi sellii tan sabu mette ɓuuɓɗe puɗɗaaɗe ɗee ustii.

Hol ko woni pneumothorax catamenial e hol ko waɗi ɗum waɗde e nder lewru ?¶

Pneumothorax catamenial ko ɓuuɓri ɓuuɓndi, ndi heɓtotoo ko e rewɓe yahrooɓe e duuɓi 24 hade mum en haa waktuuji 72 caggal nde ɓe puɗɗii lewru, ina toɗɗii ɓuuɓri ñaamo e ko ɓuri 90 e nder teemedere. Saabi ɗum ko endometriose thoracique (ɗo ƴiye gonɗe e nder reedu ɗee njooɗii e dow ɓalndu ñaamo e pleura visceral) tawa ina wondi e ɓuuɓri tokosiri (fenestrations) e nder ɓalndu nduu, ina addana henndu e ƴiye endometrium naatde e nder ɓalndu menstruation. Kala debbo mo ɓuuɓri ɓalndu walla ɓuuɓri ɓuuɓndi e nder sahaa mum, ina foti humpitaade safroowo mum pulmonologist e gynécologue ngam feewnude diaphragme VATS targeted e therapy hormonal ina mbaawi haɗde lewru kala ruttaade.

Mbele pneumothorax spontané ina ɗaɓɓi sahaa kala ɓuuɓri ɓalndu seppo ?¶

Alaa. Ƴeewndorɗe safaara jamaanu e laabi 2023 British Thoracic Society ina kollita wonde so tawii ko a suka, so wonaa ɗuum aɗa selli (Primary Spontaneous Pneumothorax), tawa aɗa foofaa no feewi, ɓuuɓri maa ɓuuɓndi ina waawi heewde jogaade ko ina reentoo e ƴeewndo e oksijen toowɗo hay so tawii alaa tube tan walla tawa aɗa wondi e ɓuuɓri. Hay so tawii ko ɓuuɓri ina haani, safrooɓe hannde ina kuutoroo so tawii ko aspiraasiyoŋ jaawɗo, so tawii ko kaɓirgal ɓoorneteengal, so tawii ko kaɓirgal gonngal e laawol gootol, ngal addanta neɗɗo hootde galle ñalnde heen, walla kateter (catheter) ɓuuɓɗo no pentol nii (8 haa 14 Farayse) waɗaaɗo e les leɗɗe ɓuuɓnooje nokku oo, wonaa tuuba surgi mawɗo.

Ngol ɗoo deftere ina rokka humpitooji jaŋde ko yaawi, tee lomtinaani safaara walla ƴeewndo safaara. Sabu ɓuuɓri ɓernde e ɓuuɓri fooftere ina mbaawi yahrude yeeso e yaawre haa wonta ɓuuɓri walla ɓuuɓri ɓernde, eɗen mbaawi wasiyaade no feewi ƴettude ballal gadanal e CPR, tawa ko e ballal juuɗe, to Croix-Rouge, St John Ambulance, walla to nokku keɓtinaaɗo ngam jannginde ko yaawi.

Ardiiɓe jokkondirɓe¶

• Pneumothorax tension e ballal gadanal gaañiiɗo e ɓalndu
• Flail ɓernde, ɓuuɓri ƴiye, e ɓuuɓri ɓalndu ɓuuɓndi
• Emboli pulmonaire e trombose ƴiiƴam luggiɗɗam (DVT)
• Perikarditis, miokarditis, e ɓuuɓri ɓalndu caggal mboros ina mbaɗa banngeeji boɗeeji
• Asma attack ballal gadanal ko yaawi

Fuɗɗoode e ardorde laawɗunde¶

• Fedde Toraas Angalteer (BTS, Royaume-Uni): Fedde Toraas Angalteer ngam ñawu nguu (2023): Porotokolle tuugiiɗe e hujjaaji ngam ƴellitde njuɓɓudi gonndi e ɓuuɓri, ɓuuɓri gonndi e ɓuuɓri gonndi e ƴiiƴam, ɓuuɓri gonndi e ƴiiƴam Seldinger, ɓuuɓri gonndi e ƴiiƴam Seldinger, ɓuuɓri gonndi e ƴiiƴam Seldinger, ɓuuɓri gonndi e ƴiiƴam Seldinger, VATS aiuroi travelr kuule.
• Fedde Oropnaare Fooftere (ERS): Bayyinaango Goomu Goomu ERS ko faati e Pneumothorax Spontané Primaire: Ƴeewndo e njuɓɓudi Episodeeji gadani e Ɓooyɗi.
• Fedde Ameriknaare Toraas (ATS) e Koldaa Ameriknaajo Cafrooɓe Toraas (CHEST, Dental Dowlaaji Amerik): Njuɓɓudi Haala nanondiral Pneumothorax e *Jaaynde New England of Medicine Conservative versus Interventionnel ngam ƴeewndo Pneumothorax Spontane et.Z al.Z,*B) **B.
• Fedde safaara weeyo (AsMA) e Fedde hakkunde leyɗeele toppitiinde ko fayti e yah-ngartaa weeyo (IATA): Laabi safaara ngam yah-ngartaa e weeyo: Fittaandu fooftere ngam diwde caggal nde opereeji pneumotorax e thorax.
• Ballal nguurndam mboros hade safrirde (PHTLS) e Fedde Ameriknaare Ɓernde (AHA): Ballal Nguurndam Ɓooyngal (ACLS) Anndinde e Decompression Sock Obstructive ummoraade e Pneumothorax Tension.