Kwatsam Pneumothorax, Rushewar Alamun Huhun, da Ciwon Ƙirji na Pleuritic¶

Wani nau'in pneumothorax (wanda aka fi sani da huhu mai rushewa) yana faruwa ne lokacin da iska ta fita daga cikin huhu kuma ta kasance cikin tarko a cikin sararin samaniya, ƙananan rami mai laushi tsakanin waje na huhu da ciki na bangon kirji. Sabanin faɗuwar huhu mai rauni wanda a karyewar haƙarƙari ko rauni a ƙirji ko a rauni a kirji, wani pneumothorax na gaggawa ya buge ba zato ba tsammani a hutawa ba tare da wani tasiri na jiki ba. Yana haifar da ba zato, kaifi, soka ciwon ƙirji mai gefe ɗaya wanda ke daɗa muni da kowane numfashi (ciwowar ƙirji na pleuritic) da gajeriyar numfashi. Idan kuna zargin huhu ya rushe, kira lambar gaggawa ta gida ta hanyar mu lambobin gaggawa directory nan da nan kuma ajiye mutumin a tsaye a tsaye kuma gabaɗaya, kamar yadda duk wani huhu da ya ruguje zai iya zama mummunan tashin hankali na pneumothorax mai barazanar rai ko kwaikwayi. huhu embolism ko ciwon zuciya.

Yi wannan yanzu¶

1. Kira lambar gaggawa ta gida nan take: Kira 911 a cikin Amurka da Kanada, 112 a cikin Tarayyar Turai, 999 a Burtaniya, 000 a Ostiraliya, ko duba ƙasashen waje namu. lambobin gaggawa jeri. Faɗa wa mai aikowa cewa majiyyaci na da kwatsam, kaifi ɗaya mai kaifi ciwon ƙirji mai gefe ɗaya da ƙarancin numfashi tare da wanda ake zargi da faɗuwar huhu (pneumothorax).
2. ** Sanya mutum a cikin kwanciyar hankali madaidaiciya ko madaidaiciyar wurin zama (Matsayin Fowler) ko jingina kadan zuwa gefen raɗaɗi **: Zama a tsaye a kusurwar digiri 45 zuwa 90 yana jan gabobin ciki zuwa ƙasa tare da nauyi, yana ba da mafi girman ɗakin huhu don faɗaɗa. Kada ku taɓa tilasta majiyyaci mai ciwon ƙirji mara numfashi ya kwanta a bayansa.
3. Dakatar da duk wani motsin jiki, tafiya, tari, ko damuwa (Valsalva maneuvers)*: Kada mutum ya sauka daga matakalar zuwa motar daukar marasa lafiya, ya dauki jakunkuna, ya daga abubuwa, ko hura hanci da karfi. Kowane numfashi mai ƙarfi, tari, ko nau'in Valsalva yana fitar da ƙarin iska ta cikin ɓoyayyen ɓoyayyen ƙwayar cuta zuwa cikin kogon ƙirji kuma yana hanzarta rushewar huhu.
4. Sako da matsatstsun tufafi a kusa da ƙirji, wuya, da kugu kuma kwantar da hankalinsu: Cire kwala, kwance bel ko matsi, da koci a hankali, mara zurfi, numfashi mai sanyi. Ciki mai zurfi da tsoro ya haifar yana ƙara jujjuyawar matsi kuma yana ƙara tsananta ciwon wuka.
5. ** Gudanar da ƙarin iskar oxygen mai girma idan an horar da shi kuma an sanye shi **: Idan ana samun iskar oxygen ta gaggawa tare da abin rufe fuska ba tare da sake dawowa ba a wurin aiki, jirgin ruwa, ko asibiti, gudanar da iskar oxygen mai gudana a ** 10 zuwa lita 15 a cikin minti daya ** (sai dai idan mai haƙuri ya san riƙewar carbon dioxide na yau da kullun daga COPD mai tsanani, a cikin abin da yanayin ya yi niyya da iskar oxygen jikewar kashi 2 zuwa 88). Yawan iskar oxygen yana gyara ƙarancin iskar oxygen na jini (hypoxemia) kuma yana haɓaka sake dawo da nitrogen mai cike da tarko da kashi huɗu.
6. ** A ci gaba da kallon jajayen tutoci na Tension Pneumothorax *: Bincika wuyan mutum, lebe, bugun bugun jini, da faɗakarwar tunanin mutum kowane minti 2. Idan sun zama mai tsananin cyanotic (leban shuɗi), ruɗe, dizziness, rashin ƙarfi, numfashi na musamman, ko haɓaka jijiyoyin wuyan wuya, gaya wa masu aiko da gaggawa nan da nan cewa majiyyaci yana tabarbarewa cikin abin da ake zargi ** pneumothorax yana buƙatar rage saurin allura na gaggawa.
7. Hana duk wani tafiye-tafiye ta iska, motocin kebul na tsaunuka, da nutsewar ruwa: Ko da ciwon ƙirji yana jin sauƙi kuma ana iya sarrafa shi, mai ciwon pneumothorax ba tare da jinya ba ko kuma ba a tabbatar da shi ba dole ne ** kada ya shiga jirgin sama, ya hau kan dutse mai tsayi, ko ya shiga cikin ruwa don nutsewa ***, yayin da matsin lamba ya canza bisa ga dokar Boyle zai faɗaɗa iskar motar da ta kama da faɗuwa.

Bishiyar yanke shawara: Zafin ƙirji mai gefe ɗaya kwatsam da ƙwayar pneumothorax¶

flowchart TD
    Start["Ciwon ƙirji mai Kaifi ɗaya na Kwatsam (Mafi Muni akan Wahayi) da Mummunan Karancin Numfashi (Babu Ciwon Ƙirji)"] --> TensionCheck{"Shin WANI Tension Pneumothorax Red Tutoci Akwai? 1. Matsananciyar yunwar iska ko rashin iya magana 2. Blue lebe (cyanosis), SpO2 kasa da 90% 3. Rapid rauni bugun jini (sama da 120 bpm), hypotension, ko syncope 4. Distended wuyansa veins ko karkatar da bututun iska 5. Mara lafiya yana da COPD, asma mai tsanani, ko samun iska mai kyau."}

    TensionCheck -->|"EE: Barazanar Rayuwa Nan take"| TensionProtocol["TSORATARWA PNEUMOTHORAX KO NA BIYU: 1. Kira 911 / 112 / 999 STAT kuma ya bayyana Tension Pneumothorax 2. Ci gaba da haƙuri zaune tsaye (45 zuwa 90 digiri) kuma gaba ɗaya har yanzu 3.5 88 zuwa 92% manufa idan COPD mai tsanani) 4. KADA a yi amfani da CPAP, BiPAP, ko iska mai karfi na jaka-valve-mask kafin bugun kirji"]

    TensionCheck -->|"NO: Hemodynamically barga, magana cikakken jimloli, al'ada bugun jini"| RiskProfile{"Ƙimar Bayanan Haɗarin Mara lafiya: Firamare (PSP) vs Sakandare (SSP) vs Catamenial"}

    RiskProfile -->|"Matashi (shekaru 15 zuwa 35), dogon gini mai tsayi, mai shan taba/vaper, babu cutar huhu kafin"| PSP["Pneumothorax na Farko wanda ake zargi (PSP): Ruptured apical subpleural bleb"]
    RiskProfile -->|"Shekaru sama da shekaru 50, KO tarihin COPD, emphysema, asma, cystic fibrosis, Marfan"| SSP["Pneumothorax (SSP) da ake zargi na Sakandare: Ƙananan ajiyar huhu da babban haɗari na raguwa da sauri"]
    RiskProfile -->|"Yana faruwa a cikin sa'o'i 72 kafin ko bayan fara haila"| Catamenial["Abin da ake zargin Catamenial / Thoracic Endometriosis Pneumothorax: Yawancin gefen dama (sama da 90%)"]

    PSP --> HospitalEval["Motsa Jiki a Matsayin Zama zuwa Asibiti ED (KADA KA Yi Tafiya ko Ƙarfafawa): Tabbatar da girman ta hanyar Inspiration Chest X-Ray, Thoracic Ultrasound (rashin huhu), ko CT"]
    SSP --> HospitalEval
    Catamenial --> HospitalEval

    HospitalEval --> SizeBranch{"Bambance-bambancen Asibiti ta Girma da Alamu (BTS / ATS / Jagororin ERS)"}

    SizeBranch -->|"Ƙananan PSP (ƙasa da 2 cm rim a hilum) DA ƙarancin ko rashin numfashi"| Conservative["Kulawar Conservative + Babban Maganin Oxygen: Maimaitawa a 1.25% zuwa 2% kowace rana (4x sauri akan O2 mai girma) Maimaita X-ray a cikin awanni 4 zuwa 6, sannan bibiyar marasa lafiya tare da tsauraran NO FLYING dokar"]
    SizeBranch -->|"Babban PSP (baki 2 cm ko ya fi girma) KO Mara numfashi ko Duk wani Pneumothorax na Sakandare (SSP)"| Intervention["Active Pleural Decompression: - Simple Needle Aspiration (14G to 16G cannula) OR Ambulatory Heimlich Valve Device - Small-Bore Seldinger Chest Tube (8 to 14 Fr) connected to underwater seal - VATS pleurodesis if persistent air leak (over 3 to 5 days), recurrent, or high-risk profession"]

Pathophysiology: Yadda huhu ke rushewa ba tare da raunin kirji ba¶

A cikin ƙoshin lafiya, saman huhu na waje (visceral pleura) da bangon ciki na haƙarƙari (parietal pleura) suna manne tare a kan wani bakin ciki fim na ruwa mai laushi (mililita 10 zuwa 20 [0.3 zuwa 0.7 ruwa oces]). Saboda huhu na roba a zahiri yana komawa cikin ciki yayin da haƙarƙarin ke jan waje, sararin da ke tsakanin waɗannan membranes guda biyu yana riƙe da matsi na intrapleural ** na -3 zuwa -5 cmH2O a hutawa, yana faɗuwa zuwa -8 zuwa -10 cmH2O yayin zurfin inhalation. Wannan tsotsawar mara kyau tana sanya jakar iska (alveoli) ta kumbura a kan hakarkarinsa.

1. Apical Blebs, Bullae, da Asarar Tsotsar Pleural mara kyau¶

Ƙananan jakar iska mai kama da blister da ake kira ** subpleural blebs *** (a ƙarƙashin 1 zuwa 2 centimeters [0.4 zuwa 0.8 inci] a diamita, a cikin visceral pleura) ko mafi girma ** emphysematous bullae ** (fiye da 1 zuwa 2 centimeters, kafa ta hanyar lalata bangon alveolar) akai-akai a saman (*)

Nauyin nauyi yana jan tushe mai nauyi na huhu zuwa ƙasa zuwa diaphragm. A cikin mutumin da ke da tsayin ƙirjin ƙirji mai tsayi mai kunkuntar (gini na ectomorphic), tsayin tsayin thorax na tsaye yana haifar da tudu mai tsayi ** pleural pressure gradient ** (0.25 cmH2O a centimita na tsayin huhu). Alveoli a saman huhu yana fuskantar matsanancin matsin lamba mai banƙyama fiye da alveoli a ƙasa, yana shimfiɗa nama har sai ɓangarorin ɓangarorin ɓangarorin sirara sun fito.

Lokacin da apical bleb ya fashe ta cikin visceral pleura, buɗewar buɗewa tsakanin hanyoyin iska da kuma rami mara ƙarfi: 1. Iska yana gudu daga cikin huhu zuwa cikin sararin samaniya har sai an rasa gurɓataccen iska kuma matsa lamba na intrapleural yayi daidai da matsa lamba na yanayi (0 cmH2O). 2. An zare matattarar injin sa na waje, huhun na roba yana komawa ciki zuwa tushen sa na tsakiya (hilum), yana rugujewa gaba daya ko gaba daya. 3. Naman huhu da ya rushe ya daina shiga cikin musayar iskar gas, yana haifar da rashin daidaituwa na ** iska-perfusion (V/Q)** da shunt dama-zuwa-hagu har sai hypoxic pulmonary vasoconstriction yana jujjuya kwararar jini zuwa huhu lafiya.

2. Me yasa Oxygen Mai Ruwa Mai Ruwa Yana Saurin Sake Faruwa da Kashi 400 (Washwar Nitrogen)¶

Kusan 78 bisa dari na iskar gas ɗin da ta kama ta ƙunshi nitrogen (N2), iskar da ba ta da ƙarfi wacce ke narkewa cikin jini sosai. Karkashin numfashin daki-iska na al'ada, rufaffiyar pneumothorax ba da jimawa ba yana sake shiga cikin capillaries a cikin kawai ** 1.25 zuwa 2.2 bisa dari na girman hemithorax a cikin sa'o'i 24** (ma'ana rushewar kashi 30 yana ɗaukar makonni 2 zuwa 3 don share kansa).

Lokacin da ma'aikatan lafiya ko likitocin gaggawa suka yi amfani da ** ƙarin oxygen mai girma (lita 10 zuwa 15 a cikin minti ɗaya ta hanyar abin rufe fuska ba tare da sake numfashi ba), iskar oxygen da aka yi wahayi tana wanke nitrogen daga jinin jijiya mai yawo, yana sauke wani ɓangaren matsi na nitrogen a cikin capillaries daga kusan 573 mmHg zuwa sifili yayin da iskar oxygen ke cinye ta kyallen takarda. Wannan yana haifar da m ** partial pressure diffusion gradient ** tsakanin aljihun pleural mai arzikin nitrogen da jini mai ƙarancin nitrogen, yana fitar da iskar gas daga cikin sararin samaniya ** sau huɗu cikin sauri ** (har zuwa ** 4 zuwa 8 bisa dari na ƙimar hemithorax kowace rana).

Kwatanta nau'ikan asibiti guda huɗu na pneumothorax ba tare da bata lokaci ba¶

Fahimtar wane nau'in mara lafiya ya fada cikin jagororin jagororin, saboda matashin ɗan wasa lafiyayye tare da rugujewar kashi 25 na iya zama mai daɗi yayin hutawa, yayin da mai shekaru 65 tare da emphysema da rugujewar kashi 10 na iya shan wahala cikin hanzari.

Gane bayyanar cututtuka: Rushewar rashin rikitarwa vs. Tension Pneumothorax¶

1. Alamomin gargajiya na Sauƙaƙen Pneumothorax Mai Sauƙi¶

A cikin fiye da ** 80 bisa dari na lokuta , pneumothorax na farko ba tare da bata lokaci ba yana faruwa a hutawa maimakon lokacin motsa jiki mai nauyi: - ** Kwatsam, kaifi, ciwon ƙirji na gefe (Pleuritic Pain): Numfasawa, tari, dariya, ko karkatar da gangar jikin yana haifar da kama mai kaifi wanda ke tilastawa gajeriyar numfashi mara zurfi ("tsagawa"). - Ipsilateral kafada-tip ko babba baya (scapular) zafi : Saboda parietal pleura da ke rufe tsakiyar diaphragm yana shiga ta hanyar ** jijiyar mahaifa (tushen mahaifa C3, C4, da C5), haushi daga tserewa iska ana magana da shi zuwa saman kafada a gefe guda. - Ƙaƙƙarfan ƙarancin numfashi (Dyspnea): Ya bambanta daga matsanancin yunwar iska akan matakalai zuwa haƙar baƙin ciki yayin hutu. - ** bushewa, shiga ba tare da izini ba, tari mara amfani : Masu karɓan shimfiɗaɗɗen raɗaɗi ne ke haifar da su yayin da huhu ya ɓace. - Subcutaneous emphysema ("Rice Krispies" crackles a karkashin fata): Bibiyar iska a cikin mediastinum (pneumomediastinum) da wuyansa yana haifar da fashewa a ƙarƙashin yatsunsu ko sautin murƙushewa tare da bugun zuciya ( Alamar Hamman**). - Binciken jarrabawar jiki: Gefen da abin ya shafa ba ya motsi kadan yayin numfashi, yana jin karami lokacin da aka buga shi ( hyperresonance to percussion), kuma yana da ** rage ko rasa sautin numfashi* a lokacin auscultation.

2. Ci gaba zuwa Tension Pneumothorax: Gaggawa Ta Hanyar Hanya Daya¶

A tashin hankali pneumothorax na faruwa ne lokacin da tsagewar nama mai tsagewar ke aiki a matsayin ** bawul mai hanya ɗaya**: shakar iska tana shayar da iska daga bishiyar mashaya zuwa cikin kogon ɓacin rai, amma numfashi yana rufe murfin don kada iska ta iya tserewa.

Tare da kowane numfashi, matsi mai kyau yana ginawa a cikin kirji (+10 zuwa +20 cmH2O ko fiye): 1. Cikakken rugujewar huhun huhu na ipsilateral: Huhun da abin ya shafa ana murƙushewa a saman hilum. 2. Matsakaicin tsaka-tsaki da matsawa na huhu. 3. Kinking na Vena Cava da Shock Obstructive: Matsi na intrathoracic mai kyau yana matse ** babba da na ƙasan vena cava *** rufe. Komawar venous zuwa atrium na dama ya faɗi zuwa sifili, fitarwar zuciya yana faɗuwa cikin abu mai hanawa, kuma majiyyaci na fama da bugun zuciya** a cikin mintuna kaɗan sai dai idan an cire allura ko bututun ƙirji.

Bambance Sauƙaƙan Pneumothorax daga Tension Pneumothorax a gefen gado¶

Bambance-bambancen ganewa: Sauran abubuwan da ke haifar da ciwon kirji na pleuritic¶

Ma'aikatan jinya da likitocin gaggawa suna kimanta abubuwan gaggawar ƙirji da suka mamaye:

1. Ciwon huhu (PE): Jinin jini da ke tafiya daga jijiya mai zurfi (DVT) zuwa arteries na huhu yana haifar da ciwon ƙirji na pleuritic kwatsam, dyspnea, da tachycardia. Ba kamar pneumothorax ba, ** sautunan numfashi daidai suke a bangarorin biyu **, marasa lafiya na iya tari jini (hemoptysis), da abubuwan haɗari sun haɗa da tiyata na baya-bayan nan, dogon jirage, hana motsi, ciki, ko ciwon daji.
2. Pericarditis mai tsanani da kuma myocarditis: Yana haifar da zafin ƙirji mai kaifi na tsakiya ko na hagu wanda ke haskakawa zuwa ƙugiyar trapezius wanda ** yana ƙaruwa lokacin kwance kuma yana inganta lokacin zaune da jingina gaba **, tare da sautunan numfashi na al'ada.
3. Harin Zuciya kuma Ragewar Aortic: Ciwon zuciya yana haifar da matsananciyar matsa lamba na baya, yayin da rarrabawar aortic yana haifar da tsagewar zafi mai raɗaɗi zuwa baya (mahimmanci don yin sarauta a ** ciwon Marfan **, wanda ke haifar da pneumothorax da aortic dissection).
4. ** Rupture na Esophageal (Boerhaave Syndrome)**: Hawaye na esophageal na transmural bayan amai mai ƙarfi, sakin acid na ciki da iska a cikin mediastinum da rami na hagu.

Pre-asibiti da kulawar asibiti: Abin da za a yi tsammani daga ma'aikatan jinya da ED¶

1. Me ya sa Ingantacciyar iska (CPAP, BiPAP, ko BVM) ke da haɗari Kafin Fitar da iska.¶

Idan mara lafiya tare da pneumothorax wanda ba a gano shi ba ya zama marar numfashi, yin amfani da **CPAP, BiPAP, ko kuma iska mai ƙarfi-valve-mask (BVM). Masu amsawa koyaushe suna jin daɗin huhu biyu (kuma suna amfani da duban dan tayi a gefen gado) kafin amfani da matsi mai kyau na iska.

2. Ciwon Asibiti: Madaidaicin ƙirji X-ray vs. Thoracic Ultrasound (POCUS)¶

• ** Madaidaicin baya (PA) X-Ray na ƙirji *: Yana Nuna layin farar fata mai kaifi ( visceral pleural gefen ***) tare da alamun huhun da ba ya nan a gefen layi. Ba a buƙatar finafinan karewa na yau da kullun.
• Ma'anar Kulawa na thoracic Ultrasound (POCUS): Yana gano pneumothorax a cikin ƙasa da daƙiƙa 30 tare da mafi girman hankali fiye da X-ray na baya. Huhun da ya ruguje yana nuna **Rashin zamewar huhu ***, rashi layin comet-tail B-line, lambar lamba "alamar stratosphere" akan yanayin M-, da gano cutar "maki huhu".

3. Zaɓuɓɓukan Jiyya na Zamani: Dubawa, Buga, Bututun Kirji, da VATS¶

Daidaita tare da **2023 British Thoracic Society (BTS) Jagoran Cutar Cutar Pleural ** da gwaji na duniya:

1. ** Gudanar da Conservative (Kaɗai Kulawa) **: Ga matasa, marasa lafiya masu lafiya tare da ** Primary Spontaneous Pneumothorax (PSP) waɗanda ke da ** ƙarancin ko rashin numfashi ** da kwanciyar hankali, kallo tare da iskar oxygen mai girma da maimaita x-ray na kirji a cikin sa'o'i 4 yana ba da damar hawaye don warkewa ta zahiri ba tare da allura ko bututu ba.
2. ** Sauƙaƙawar Buƙatar Allura ko Ambulatory Heimlich Valve ***: Ga marasa lafiya na PSP marasa numfashi, likitoci na iya yin amfani da iska ta hanyar **14G zuwa 16G cannula ** (har zuwa lita 2.5 [2.6 quarts]) ko shigar da motar motar asibiti mai ɗauke da kai (8 Fr catheter tare da faɗuwar bawul mai sama da 2). Kwanaki 4.
3. ** Karamin-Bore Seldinger Intercostal Chest Drain (8 Fr zuwa 14 Fr)**: Don Na biyu Spontaneous Pneumothorax (SSP), gazawar buri, ko babban bayyanar cututtuka ya ruguje, likitoci sun shigar da catheter na Faransa mai lamba 8 zuwa 14 ** a ƙarƙashin maganin sa barci ta cikin gida ta hanyar **"Triangle na Safessity. dorsi, 5^th intercostal sarari, da axilla), an haɗa su zuwa ** kwalban hatimin ƙarƙashin ruwa **.
4. ** Ragewar Allurar Gaggawa (Thoracostomy): Don tashin hankali pneumothorax tare da girgiza, likitocin sun saka cannula mai girma (14G, tsayin 4.5 zuwa 8 centimeters [1.75 zuwa 3.25 inci]) cikin **2^nd intercostal sarari tsakiyar clavicular line ko 5^th intercostal sarari tsakiyar clavicular line. layin midaxillary ** (kawai sama da gefen haƙarƙari na sama), yana fitar da matsa lamba nan da nan.
5. ** Rigakafin Rigakafi na Maimaitawa (VATS Bullectomy da Pleurodesis): Don ci gaba da leaks na iska (fiye da kwanaki 3 zuwa 5), maimaita pneumothorax, ko manyan ƙwararrun ƙwararrun (matukin jirgi, divers), ** Taimakon Taimakawa Thoracoscopic Surgery (VATS)**al staples Pleura ta hanyar ** abrasion, pleurectomy, ko talc poudrage **, yana rage maimaitawa daga ** 30 zuwa 50 bisa dari zuwa kashi 1 zuwa 5 **.

Tsayin tsayi, balaguron iska, nutsewar ruwa, da rigakafi bayan murmurewa¶

Da zarar pneumothorax ba zato ba tsammani ya warke kuma an sallami majiyyaci gida, ƙayyadaddun tsarin rayuwa da ƙa'idodin salon rayuwa suna ba da kariya daga sake dawowa mai mutuwa:

• ** Dokokin Jiran Balaguro na Kasuwanci (BTS & Ƙungiyar Likitocin Aerospace) ***:
• Dole ne ku KADA KA tashi da wani abu mai aiki, saura, ko rashin maganin pneumothorax na kowane girman.
• Da zarar X-ray na kirji bayan jiyya ya tabbatar ** 100% cikakken ƙuduri na rediyo ** (huhun yana da cikakkiyar faɗaɗa a bangon kirji tare da aljihun iska mara nauyi), British Thoracic Society ya ba da shawarar jira aƙalla ** cikakkun kwanaki 7 bayan X-ray na yau da kullun (kuma yawancin kamfanonin jiragen sama da Ƙungiyar Likitocin Aerospace sun ba da shawarar jira ** 14 kwanaki bayan cikakken ƙudurin rediyon jirgin sama), kafin su hau jirgin sama. baya buɗawa lokacin da matsatsin gida ya faɗi a tsayi.
• Ƙuntatawa Diving Scuba na dindindin:
• Domin hawan daga ko da wurin wanka mai nisan mita 10 (ƙafa 33) ko nutsewar teku ya ninka adadin duk wani iskar gas da ke danne kuma yana iya haifar da mutuwa ** Barotrauma na huhu da cututtukan iskar gas (AGE), tarihin pneumothorax ba tare da bata lokaci ba shine ** cikakkiyar maƙasudin dindindin ga scubagorgigi * sai dai idan mutum yana da matsa lamba. pleurectomy kuma sun wuce CT na musamman na ƙirji mai ƙarfi da aikin aikin huhu tare da ƙwararren likitan ruwa.
• Dakatar da Shan Sigari da Guba Gaba ɗaya:
• Ci gaba da shan taba sigari, haɗin gwiwar cannabis/bongs (wanda ya haɗa da zurfafawa mai zurfi da ɗaukar dogon numfashi na Valsalva), ko sigari/vapes na lantarki shine mafi girman direban sake dawowa. Dakatar da duk hayaki da tururi da aka shaka yana rage haɗarin faɗuwar huhu na biyu daga ** sama da kashi 40 zuwa 50 zuwa kusan kashi 15 zuwa 20**.
• **Kauce wa Hatsi mai nauyi, Kayan aikin iska, da Wasannin Tuntuɓar Makonni 2 zuwa 4 ***:
• Jira har sai cikakkiyar farfadowar rediyo da izini daga likitan huhu kafin komawa zuwa ɗaukar nauyi mai nauyi (kauce wa ɗagawar Valsalva mai ɗaukar numfashi), kunna babban juriya na tagulla ko kayan kidan itace, ko shiga cikin wasannin tuntuɓar.

Lambobin gaggawa na yanki da ka'idojin hukumar¶

• Amurka da Kanada: Kira 911 nan take don ciwon ƙirji kwatsam da ƙarancin numfashi. Ma'aikatan jinya na asibiti suna bin ** Ƙungiyar Zuciya ta Amirka (AHA) ** da ** Tallafin Rayuwa na Rayuwa na Prehospital (PHTLS) / Ƙungiyar Ƙungiyar EMS ta Likitoci (NAEMSP) ** ka'idoji don gudanar da iskar oxygen mai girma, bugun jini oximetry, da gaggawa na allurar thoracostomy (2^nd intercostal space midclavicular line) ko layin tsakiya na tsakiya ko 4^th a sararin samaniya. ilimin lissafi yana tasowa. Gudanar da asibiti yana bin ** American Thoracic Society (ATS)** da ** American College of Chest Physicians (Chest)** jagororin.
• ** United Kingdom ***: Kira 999 don motar asibiti ta gaggawa (m ciwon kirji tare da rashin numfashi koyaushe kiran 999 ne). Kulawar asibiti ta bi ka'idodin British Thoracic Society (BTS) 2023 Jagoran Cutar Cutar Pleural da NICE, waɗanda ke tafiyar da kulawar ra'ayin mazan jiya, majinyata marasa lafiya na marasa lafiya, da Seldinger ƙananan magudanar ruwa.
• Tarayyar Tarayyar Turai: Dial 112 a duk ƙasashe membobin EU. Hospital teams follow the European Respiratory Society (ERS) task force clinical practice guidelines for primary and secondary spontaneous pneumothorax, using bedside thoracic ultrasound, digital chest drainage systems, and early VATS consultation.
• ** Ostiraliya da New Zealand ***: Kira 000 a Ostiraliya ko 111 a New Zealand. Ayyukan motar asibiti da sassan gaggawa sun bi ** Thoracic Society of Australia da New Zealand (TSANZ) ** da ** Ostiraliya da Kwamitin New Zealand game da Resuscitation (ANZCOR) *** jagororin, haɗawa da fahimta daga alamar ANZ Multi-Centre Conservative vs. PSP gwaji.
• Indiya da Asiya-Pacific: Kiran kira 112 a Indiya, 995 a Singapore,119* a Japan da Koriya ta Kudu, ko 999 a Hong Kong da Malaysia. Nemi motar asibiti ta Advanced Life Support (ALS) sanye take da iskar oxygen kuma sanar da sashin gaggawa na gaggawa don shirye-shiryen rediyon ƙirji madaidaiciya da ɓacin rai.

Tambayoyin da ake yawan yi¶

Me yasa dogayen samari masu sirara da shekaru matasa da ashirin suke da saurin rugujewar huhu?¶

Yayin saurin girma na samari, tsayi, kunkuntar kogon kirji yana haifar da matsananciyar nauyi a tsaye daga saman huhu zuwa tushe. Jakunkunan iska (alveoli) a saman kololuwar huhu suna fuskantar matsanancin matsa lamba mai ƙarfi fiye da sauran huhu, yana haifar da ƙananan blister-kamar ƙananan ƙumburi zuwa saman lobes na sama. Idan ɗaya daga cikin waɗannan blisters na bakin ciki mai katanga ya fashe (musamman idan ƙananan kumburin iska daga shan taba ko vaping ya raunana), iska ta shiga cikin sararin samaniya mara kyau kuma ta rushe huhu koda a zaune.

Yaya tsawon lokacin da huhun da ya fadi ya warke, shin zai yiwu a tashi a jirgin sama na kasuwanci?¶

Kada ku taɓa shiga jirgin sama yayin da duk wani ragowar pneumothorax yana nan akan X-ray na ƙirji, saboda matsawar tsayin gida yana haifar da tarkon iskan ƙirji don faɗaɗa da kashi 25 zuwa 38 cikin ɗari. A cewar British Thoracic Society (BTS), dole ne ku jira aƙalla 7 cikakkun kwanaki bayan x-ray mai biyo baya ya tabbatar da 100 bisa dari cikakken ƙuduri na pneumothorax (kuma yawancin kamfanonin jiragen sama da Ƙungiyar Likitocin Aerospace suna buƙatar jira 14 kwanaki bayan cikakken ƙuduri na rediyo) kafin tashi.

Zan iya sake nutsewa bayan na sami pneumothorax na kwatsam?¶

A karkashin British Thoracic Society, Divers Alert Network (DAN), da jagororin likitancin ruwa na kasa da kasa, pneumothorax na baya-bayan nan na baya-bayan nan shine mai hana ruwa gudu daga ruwa tare da iska mai matsa lamba, koda bayan huhu ya warke gaba daya har ma bayan daidaitaccen talc ko abrasion pleurodesis. Matsanancin matsa lamba yana canzawa a ƙarƙashin ruwa yana iya ɓarkewar ƙananan ƙwayoyin cuta a cikin ko dai huhu kuma yana faɗaɗa iskar da aka kama da kashi 200 zuwa 400 yayin hawan, yana haifar da tashin hankali pneumothorax kafin ya isa saman; 'Yan takarar da ba kasafai ba ne kawai waɗanda aka yi wa tiyata na biyu kuma suna da cikakken gwajin gwajin CT na yau da kullun da gwaje-gwajen aikin huhu don sharewa daga likitan ruwa.

Me yasa zafin kirjina ya fara samun sauki a rana ta biyu duk da cewa likita ya ce huhuna ya fadi har yanzu?¶

Lokacin da iska ta fara zubowa cikin kogon huhu kuma ta cire huhu daga bangon ƙirji, tana shimfiɗawa kuma tana harzuka zaruruwan zafi a cikin parietal pleura, yana haifar da zafi mai tsanani tare da kowane numfashi. Da zarar huhu ya gama jujjuyawa zuwa tsayayyen yanayi bayan sa'o'i 12 zuwa 24, tsagawar aiki da matsa lamba suna tsayawa, don haka kaifi zafi yakan dushe cikin ciwo mai raɗaɗi ko ƙarancin ƙarfi ko da yake huhun ya rage kashi 30 zuwa 60 cikin ɗari. Kar a taɓa ɗauka cewa huhun da ya faɗo ya warke kawai saboda ciwon soka na farko ya lafa.

Menene pneumothorax catamenial kuma me yasa yake faruwa a lokacin haila?¶

Katamenial pneumothorax wani huhu ne da ya sake rushewa wanda ke faruwa a cikin mata masu shekarun haihuwa a cikin sa'o'i 24 kafin zuwa sa'o'i 72 bayan fara jinin haila, yana shafar huhu na dama a fiye da kashi 90 na lokuta. Yana faruwa ne ta hanyar thoracic endometriosis (inda ƙananan ƙwararrun ƙwayoyin mahaifa na rufin mahaifa suka zauna akan diaphragm na dama da visceral pleura) hade da ƙananan ramuka na haihuwa (fenestrations) a cikin diaphragm wanda ke ba da damar iska da nama na endometrial su shiga cikin rami a cikin kirji lokacin haila. Duk macen da ta sami ciwon ƙirji ko huhun da ya ruguje a kusa da al'ada ya kamata ta sanar da likitan huhu da likitan mata don haka gyaran VATS diaphragmatic da maganin hormonal zai iya hana sake dawowa kowane wata.

Shin pneumothorax na kwatsam ko da yaushe yana buƙatar bututun ƙirji mai raɗaɗi?¶

A'a. Gwajin gwajin asibiti na zamani da jagororin 2023 na British Thoracic Society sun nuna cewa idan kun kasance matashi, in ba haka ba lafiya (Primary Spontaneous Pneumothorax), kuma ba numfashi mai mahimmanci ba, huhun ku na rugujewa sau da yawa ana iya sarrafa shi ta hanyar kiyayewa tare da lura da iskar oxygen mai girma kadai ba tare da wani allura ko bututu ba. Ko da lokacin da ake buƙatar magudanar ruwa, likitoci a yau suna amfani da ko dai buƙatun allura mai sauri, na'urar bawul mai girman dabino mai iya sawa wanda zai baka damar komawa gida a wannan rana, ko kuma fensir mai sassauƙa mai sauƙi (8 zuwa 14 Faransanci) wanda aka sanya a ƙarƙashin maganin ƙididdigewa na gida maimakon babban bututun tiyata.

*Wannan jagorar tana ba da bayanan ilimi na gaggawa kuma baya maye gurbin ƙwararrun kulawar likita ko ganewar asali. Saboda matsanancin ciwon ƙirji da damuwa na numfashi na iya ci gaba da sauri zuwa girgiza mai barazanar rai ko kamawar zuciya, muna ba da shawarar ɗaukar ƙwararrun ƙwararrun taimako na farko da kwas na CPR daga Red Cross, St John Ambulance, ko kuma mai ba da horo na gaggawa na gida.

Jagora masu alaƙa¶

• Tashin hankali pneumothorax da tsotsar raunin ƙirji taimakon farko
• Ƙirjin ƙirji, karyewar haƙarƙari, da raunin thoracic
• Cutar kumburin huhu da thrombosis mai zurfi (DVT)
• Pericarditis, myocarditis, da post-viral ciwon kirji ja tutoci
• Asma ta kai agajin gaggawa na gaggawa

Tushen da jagorar hukuma¶

• British Thoracic Society (BTS, United Kingdom): *Jagorancin Societyungiyar Thoracic Society na Burtaniya don Cutar Pleural (2023): Ka'idodin tushen shaida don kulawar ra'ayin mazan jiya, buɗaɗɗen motsin motsa jiki, buƙatun allura, magudanar ƙirji na VATS, VATS pleurodesis, ƙuntatawa na tafiye-tafiyen iska.
• European Respiratory Society (ERS): ERS Task Force Statement on Primary Spontaneous Pneumothorax: Diagnosis and Management of First and Recurrent Episodes.
• ** American Thoracic Society (ATS) da American College of Chest Physicians (chest, United States):** * Gudanar da Bayanin Yarjejeniya ta Pneumothorax na Kwatsam * da * New England Journal of Medicine Conservative tare da Maganin Interventional for Primary Spontaneous Pneumothorax Trial (Brown et al., ANZ)*.
• ** Associationungiyar Likitocin Aerospace (AsMA) da Ƙungiyar Sufurin Jiragen Sama ta Duniya (IATA):** Sharuɗɗan Likita don Balaguron Jirgin Sama: Natsuwa da Lafiyar Jiki don Tashi Bayan Pneumothorax da Tiyatar Thoracic.
• ** Tallafin Rayuwa na Rayuwa na Prehospital Trauma (PHTLS) da Ƙungiyar Zuciya ta Amurka (AHA):** * Taimakon Rayuwa na Ciwon Jiki na Zuciya (ACLS) Ganewa da Rushewar Shock Mai Tsaya daga Tension Pneumothorax*.