Spontaneous Pneumothorax, Obubonero bw’amawuggwe okugwa, n’obulumi mu kifuba mu Pleuritic¶

Ekifuba ekiyitibwa pneumothorax (ekitera okuyitibwa amawuggwe ekigudde) kibaawo ng’empewo ekulukuta okuva mu bitundu by’amawuggwe n’esibira munda mu kifo ky’amawuggwe, ekituli ekigonvu ekisiigiddwa amazzi wakati w’ebweru w’amawuggwe n’omunda mu bbugwe w’ekifuba. Okwawukanako n’amawuggwe agagwa mu ngeri ey’ekikangabwa nga gava ku a okumenya embiriizi oba okulumwa mu kifuba mu ngeri etali ya maanyi oba a ekiwundu ekiyingira mu kifuba, ekifuba ekiva mu kifuba kikuba mu bwangu ng’owummudde awatali kukosebwa kwonna mu mubiri. Kireeta obulumi mu kifuba obw’amangu, obusongovu, obufumita ku ludda olumu nga bweyongera buli lw’ossa (pleuritic chest pain) n’okussa obubi mu bwangu. Bw’oba ​​oteebereza nti amawuggwe gagudde, kuba ku nnamba y’amangu mu kitundu kyo ng’oyita ku... ennamba z’amangu directory amangu ago n’okukuuma omuntu ng’atudde nga yeegolodde era nga musirise ddala, anti amawuggwe gonna agagwa gayinza okwonooneka ne gafuuka tension pneumothorax eyinza okutta omuntu oba okukoppa a okuzimba amawuggwe oba okulwala omutima.

Kino kikole kati¶

1. Kuba ennamba yo ey’amangu mu kitundu kyo amangu ddala: Kuba 911 mu Amerika ne Canada, 112 okwetoloola omukago gwa Bulaaya, 999 mu Bungereza, 000 mu Australia, oba kebera ku nsi yaffe ey’ensi yonna ennamba z’amangu lisiti. Buulira omusindika nti omulwadde alina obulumi obw’amangu, obw’amaanyi obw’oludda olumu mu kifuba n’okussa obubi nga kiteeberezebwa nti amawuggwe gagudde (pneumothorax).
2. Teeka omuntu mu mbeera ennungi ey’okutuula nga yeegolodde oba nga yeegolodde (fowler’s position) oba nga weesigamye katono ku ludda oluluma: Okutuula nga weegolodde mu kkoona lya diguli 45 okutuuka ku diguli 90 kisika ebitundu by’olubuto wansi n’amaanyi ag’ekisikirize, ne kiwa amawuggwe agatakoseddwa ekifo ekisinga okugaziwa. Tokaka mulwadde alumizibwa mu kifuba nga tassa kugalamira ku mugongo.
3. Komya okufuba kwonna okw’omubiri, okutambula, okusesema, oba okunyigirizibwa (Valsalva maneuvers): Toleka muntu oyo kukka ku madaala okutuuka mu ambyulensi, okusitula ensawo, okusitula ebintu, oba okufuuwa ennyindo n’amaanyi. Buli mukka ogw’amaanyi, okusesema oba Valsalva strain evuga empewo ennyingi okuyita mu pleural bleb eyakutuse okuyingira mu kifuba era kwanguyiza amawuggwe okugwa.
4. Sumulula engoye ezinywezeddwa mu kifuba, mu bulago, ne mu kiwato era okkakkanye okussa kwabwe: Sumulula enkokola, sumulula emisipi oba obuleega obunywezeddwa, era otendeka okussa empola, okutali kwa maanyi, okukkakkamu. Okussa omukka mu buziba obuva ku kutya kyongera okuwuubaala kwa puleesa y’ekibumba n’okwongeza obulumi obw’okufumita.
5. Muwa oxygen ey’okugatta ku mugendo omungi singa oba otendekeddwa era ng’olina ebikozesebwa: Singa ssiringi ya oxygen ey’amangu erimu masiki etali ya kuddamu kussa ebaawo ku mulimu, eryato eribuuka mu mazzi, oba mu ddwaaliro, ssaako oxygen akulukuta ennyo ku liita 10 ku 15 buli ddakiika (okuggyako ng’omulwadde amanyi okusigala kwa kaboni dayokisayidi okutambula obutasalako okuva mu COPD ey’amaanyi, mu mbeera eyo genderera okujjula oxygen okw’amaanyi ebitundu 88 ku 92 ku buli 100 okutuusa ng’abajjanjabi abasookerwako batuuse nga balondoola omukka mu musaayi). Okisigyeni akulukuta ennyo atereeza okisigyeni omutono mu musaayi (hypoxemia) era ayanguyiza okuddamu okunyiga nayitrojeni w’omu kibumba akwatiddwa n’ensonga nnya.
6. Laba obutasalako bbendera emmyufu ez’obulwadde bwa Tension Pneumothorax: Kebera ensingo y’omuntu, emimwa gye, omukka gwe, n’obutebenkevu bw’obwongo buli luvannyuma lwa ddakiika 2. Singa bafuuka ba cyanotic ennyo (emimwa gya bbululu), ne batabulwa, ne baziyira, ne bakendeera puleesa, ne bassa mu ngeri ey’ekitalo, oba ne bafuna emisuwa gy’ensingo egyagaziwa, tegeeza abasindika eby’amangu amangu ddala nti omulwadde agenda ayonooneka n’afuuka ekiteeberezebwa nti tension pneumothorax nga kyetaagisa okukendeeza amangu empiso y’omusawo omujjanjabi.
7. Kugaana entambula zonna ez’ennyonyi, mmotoka z’oku nsozi, n’okubuuka mu mazzi: Ne bwe kiba nti obulumi mu kifuba awulira nga butono era nga busobola okuddukanyizibwa, omuntu alina obulwadde bw’ekifuba obutajjanjabiddwa oba obutakakasibwa alina obutalinnya nnyonyi, kuvuga ku nsozi empanvu eziyita, oba okuyingira mu mazzi okubbira, kubanga enkyukakyuka za puleesa ezifugibwa etteeka lya Boyle zijja kugaziya empewo y’omu kifuba ekwatiddwa n’emisuwa gy’omutima egy’okufa okugwa.

Omuti gw’okusalawo: Obulumi bw’ekifuba obw’amangu ku ludda olumu n’okusunsulamu ekifuba¶

flowchart TD
    Start["Obulumi bw’ekifuba obw’amangu obw’oludda olumu (Obubi ku kufuuwa) n’okussa ennyo (Tewali buvune mu kifuba)"] --> TensionCheck{"Waliwo Bendera Emmyufu Z'ekifuba Eziriwo? 1. Extreme air hunger or inability to speak 2. Blue lips (cyanosis), SpO2 below 90% 3. Rapid weak pulse (over 120 bpm), hypotension, or syncope 4. Distended neck veins or deviated windpipe 5. Patient has COPD, severe asthma, or positive-pressure ventilation"}

    TensionCheck -->|"YEE: Obulamu obw’amangu"| TensionProtocol["OKUTEBEREZEBWA OBUKAKAFU OBA OBULUNGI OBW’OKWESIMBA: 1. Kuba 911 / 112 / 999 STAT era olangirire nti oteeberezebwa okuba n’okusika omuguwa 2. Kuuma omulwadde ng’atudde nga yeegolodde (diguli 45 ku 90) era ng’atudde ddala 3. Siiga O2 eyali ewunyiriza ennyo (10 ku 15 L/min okuyita mu non-rebreather;"]

    TensionCheck -->|"NEDDA: Hemodynamically stable, okwogera sentensi enzijuvu, normal pulse"| RiskProfile{"Weekenneenye ebikwata ku bulabe bw’omulwadde: Primary (PSP) vs Secondary (SSP) vs Catamenial"}

    RiskProfile -->|"Omuto (15 to 35 yrs), muwanvu/mugonvu build, smoker/vaper, talina bulwadde bwa mawuggwe nga tebunnabaawo"| PSP["Ekiteeberezebwa nti Primary Spontaneous Pneumothorax (PSP): Okukutuka kw’ekibumba ekiyitibwa apical subpleural bleb"]
    RiskProfile -->|"Emyaka egisukka mu 50 yrs, OBA ebyafaayo bya COPD, emphysema, asima, cystic fibrosis, Marfan"| SSP["Suspected Secondary Spontaneous Pneumothorax (SSP): Okutereka kw’amawuggwe okwa wansi n’obulabe obw’amaanyi obw’okukendeera amangu"]
    RiskProfile -->|"Kibaawo mu ssaawa 72 nga tannatandika nsonga oba oluvannyuma lw’okutandika"| Catamenial["Ekiteeberezebwa okuba nga kya Catamenial / Thoracic Endometriosis Pneumothorax: Mu bujjuvu kibeera ku ludda olwa ddyo (ebitundu ebisukka mu 90%) ."]

    PSP --> HospitalEval["Okutambuza mu mbeera y’okutudde okutuuka mu ddwaaliro ED (TOTAMBULA oba Dduyiro): Kakasa sayizi ng’oyita mu Upright Inspiration Chest X-Ray, Thoracic Ultrasound (absent lung sliding), oba CT"]
    SSP --> HospitalEval
    Catamenial --> HospitalEval

    HospitalEval --> SizeBranch{"Okusunsula mu ddwaaliro okusinziira ku bunene n’obubonero (BTS / ATS / ERS Guidelines) ."}

    SizeBranch -->|"PSP entono (wansi wa sentimita 2 ku rim ku hilum) ERA okussa okutono oba obutassa"| Conservative["Conservative Observation + High-Flow Oxygen Therapy: Eddamu okunyiga ku 1.25% ku 2% buli lunaku (4x faster on high-flow O2) Ddamu X-ray mu ssaawa 4 ku 6, olwo ogoberere abalwadde abatali balwadde n’etteeka erikakali erya NO FLYING"]
    SizeBranch -->|"PSP Ennene (2 cm rim oba ennene) OBA Etaliimu mukka OBA Ensi yonna ey’ekifuba ey’okubiri (SSP) ."| Intervention["Active Pleural Decompression: - Simple Needle Aspiration (14G to 16G cannula) OBA Ambulatory Heimlich Valve Device - Small-Bore Seldinger Chest Tube (8 ku 14 Fr) eyungiddwa ku seal wansi w’amazzi - VATS pleurodesis singa empewo efuluma obutasalako (okusukka ennaku 3 ku 5), okuddamu, oba omulimu ogw’akabi ennyo"]

Pathophysiology: Engeri amawuggwe gye gagwa nga tewali buvune mu kifuba¶

Mu kifuba ekiramu, ekitundu eky’ebweru eky’amawuggwe (visceral pleura) n’ekisenge eky’omunda eky’olubavu (parietal pleura) binywerera wamu okubuna ekitundu ekigonvu eky’amazzi g’omu kifuba (milliliters 10 ku 20 [0.3 ku 0.7 fluid ounces]). Olw’okuba amawuggwe aga laasitiki mu butonde gadda emabega munda ate ng’olubavu lusika ebweru, ekifo wakati w’obuwuka buno obubiri kikuuma puleesa ya sub-atmospheric (negative) intrapleural pressure eya -3 ku -5 cmH2O nga ewummudde, nga ekka okutuuka ku -8 ku -10 cmH2O mu kiseera ky’okussa ennyo. Okusonseka kuno okw’obuziba (negative vacuum suction) kukuuma ensawo z’empewo (alveoli) nga zifuukuuse ku mbavu.

1. Apical Blebs, Bullae, n’okufiirwa okusonseka kw’ennyindo okutali kwa maanyi¶

Ensawo z’empewo entonotono eziringa ebizimba eziyitibwa subpleural blebs (wansi wa sentimita emu ku bbiri [yinsi 0.4 ku 0.8] mu buwanvu, munda mu visceral pleura) oba ennene emphysematous bullae (okusukka sentimita emu ku bbiri, ezikolebwa ebisenge by’amasimu ebisaanyeewo) bitera okukula waggulu (entikko) . wa bitundu by’amawuggwe ebya waggulu.

Ensikirizo esika omusingi omuzito ogw’amawuggwe wansi nga gugenda mu kisenge ky’amawuggwe. Mu muntu alina ekifuba ekiwanvu era ekifunda (ekizimbe ekitali kya bweru), obugulumivu obw’ennyiriri obw’ekifuba buleeta pleural pressure gradient (0.25 cmH2O buli sentimita y’obuwanvu bw’amawuggwe). Ensigo eziri waggulu ennyo ku mawuggwe zifuna puleesa y’okusika ey’amaanyi ennyo (negative distending traction pressure) okusinga ennywanto eziri wansi, ne zigolola ekitundu ky’oku ntikko okutuusa ng’ebikuta ebigonvu eby’omu mawuggwe bikola.

Ekitundu ekiyitibwa apical bleb bwe kyakutuka okuyita mu visceral pleura, ekifo ekiggule kitondebwa wakati w’emikutu gy’empewo n’ekisenge ky’omubiri ekiyitibwa negative-pressure pleura cavity: 1. Empewo efubutuka okuva mu mawuggwe n’eyingira mu kifo ky’amawuggwe okutuusa ng’obuziba obubi (negative vacuum) bufiiriddwa era puleesa y’omu mawuggwe yenkanankana ne puleesa y’empewo (0 cmH2O). 2. Nga eggyiddwako ekisiba kyayo eky’ebweru eky’obuziba, amawuggwe aga laasitiki gadda emabega nga gagenda munda nga gagenda mu kikolo kyago eky’omu makkati (hilum), ne gagwa ekitundu oba ddala. 3. Ebitundu by’amawuggwe ebigudde bikoma okwetaba mu kuwaanyisiganya ggaasi, ne bikola ventilation-perfusion (V/Q) mismatch ne shunt okuva ku ddyo okudda ku kkono okutuusa nga hypoxic pulmonary vasoconstriction ekyusa okutambula kw’omusaayi okudda mu mawuggwe amalamu.

2. Lwaki Oxygen Akulukuta Omungi Ayanguyiza Okuddamu Okunyiga Ebitundu 400 Ku Kikumi (Nitrogen Washout) .¶

Ebitundu nga 78 ku buli 100 ebya ggaasi w’ekibumba akwatiddwa bibaamu nayitrojeni (N2), ggaasi etakola era esaanuuka obubi mu musaayi. Wansi w’okussa okwa bulijjo mu mpewo y’ekisenge, ekifuba ekiggaddwa ekyetongodde kiddamu okunyiga mu misuwa gy’omu kifuba ku bitundu 1.25 ku 2.2 ku buli 100 byokka eby’obunene bw’ekifuba buli ssaawa 24 (ekitegeeza nti okugwa kwa bitundu 30 ku buli 100 kutwala wiiki 2 ku 3 okulongoosebwa ku bwakyo).

Abasawo abasookerwako oba abasawo ab’amangu bwe basiiga high-flow supplemental oxygen (liita 10 ku 15 buli ddakiika nga bayita mu masiki etali ya kussa), okisigyeni efuumuuddwa anaaza nayitrojeni okuva mu musaayi gw’emisuwa ogutambula, n’ekka puleesa y’ekitundu kya nayitrojeni mu misuwa gy’omu lubuto okuva ku mmHg nga 573 okutuuka ku ziro ate oxygen ow’emisuwa anywa ebitundu by’omubiri. Kino kireeta partial pressure diffusion gradient enkulu wakati w’ensawo y’omu kifuba erimu nayitrojeni n’omusaayi gw’emisuwa ogutaliimu nayitrojeni, ne gusika omukka ogukwatiddwa okuva mu kifo ky’ennyindo emirundi ena amangu (okutuuka ku ebitundu 4 ku 8 ku buli 100 eby’obuzito bwa hemithorax buli lunaku).

Okugeraageranya ebika bina eby’obujjanjabi eby’obulwadde bwa pneumothorax obw’okwekolako¶

Okutegeera ekika omulwadde ky’agwamu kilungamya okulonda, kubanga omuzannyi omuto omulamu obulungi ng’agwa ebitundu 25 ku 100 ayinza okulabika ng’ateredde ng’awummudde, so ng’ate ow’emyaka 65 alina obulwadde bwa emphysema n’okugwa ebitundu 10 ku 100 asobola okukwatibwa amangu olw’obutaba na mukka gwa mukka.

Okutegeera obubonero: Okugwa okutali kwa buzibu vs. Tension Pneumothorax¶

1. Obubonero bwa Classic obw’ekifuba eky’enjawulo eky’okwekolako¶

Mu misango egisukka mu 80 ku buli 100, obulwadde bw’ekifuba obusookerwako obw’okwekolako bubaawo mu kuwummula okusinga mu kiseera ky’okukola dduyiro ow’amaanyi: - Obulumi bw'ekifuba obw'amangu, obusongovu, obufumita ku ludda olumu (Pleuritic Pain): Okussa omukka omungi, okusesema, okuseka, oba okukyusakyusa omubiri kireeta okukwata okusongovu okuwaliriza okussa okumpi, okutali kwa maanyi ("splinting"). - Obulumi bw’omutwe gw’ekibegabega oba ogwa waggulu (scapular): Olw’okuba ekitundu ky’omubiri ekiyitibwa parietal pleura ekibikka ekitundu ekiri wakati kibeera n’obusimu obuyitibwa phrenic nerve (cervical roots C3, C4, ne C5), okunyiiga okuva mu mpewo efuluma kujuliziddwa waggulu ku kibegabega ku ludda lwe lumu. - Okussa obubi ennyo (Dyspnea): Kitandikira ku njala y’empewo etali ya maanyi ku madaala okutuuka ku kussa omukka ng’owummudde. - Okusesema okukalu, okusalako, okutali kwa bibala: Kuva ku bitundu ebiyitibwa pleural stretch receptors ng’amawuggwe gafulumya omukka. - Subcutaneous emphysema ("Rice Krispies" crackles under the skin): Empewo okulondoola mu mediastinum (pneumomediastinum) n'ensingo efulumya crackling wansi w'engalo oba eddoboozi erinyiga n'okukuba kw'omutima (Hamman's sign). - Ebizuuliddwa mu kukebera omubiri: Oludda olukoseddwa lutambula kitono nga lussa, luwulikika nga luliko ekituli nga lukubiddwa (hyperresonance to percussion), era lulina amaloboozi g’omukka agakendedde oba agataliiwo ku kuwuliriza.

2. Okugenda mu maaso okutuuka ku Tension Pneumothorax: Embeera ey’amangu eya Valve ey’engeri emu¶

tension pneumothorax ebaawo ng’ekitundu ky’omu kifuba ekyakutuse kikola nga valvule ey’engeri emu: okussa kusonseka empewo okuva mu muti gw’ennyindo n’eyingira mu kisenge ky’ennyindo, naye okufulumya omukka kusiba ekifuba ne kiggalwawo empewo n’etasobola kufuluma.

Buli lw’ossa, puleesa ennungi ezimba munda mu kifuba (+10 okutuuka ku +20 cmH2O oba okusingawo): 1. Complete ipsilateral lung collapse: Amawuggwe agakoseddwa ganyigirizibwa nga gafuukuuse ku hilum. 2. Okukyuka kw’amawuggwe ag’omu makkati n’okunyigirizibwa kw’amawuggwe agatali gamu: Puleesa egenda erinnya esika omutima, omudumu gw’empewo (trachea), n’emisuwa eminene okuyita mu layini eya wakati okuyingira mu ludda olulamu, n’enyigiriza amawuggwe agasigadde. 3. Kinking of the Vena Cava and Obstructive Shock: Puleesa ennungi ey’omu kifuba esika omusuwa ogw’okungulu n’ogw’okunsi okuggalawo. Okudda kw’emisuwa mu musuwa ogwa ddyo kukka okutuuka ku ziro, okufuluma kw’omutima kukka nnyo mu obstructive shock, era omulwadde n’afuna Pulseless Electrical Activity (PEA) cardiac arrest mu ddakiika ntono okuggyako ng’afulumiziddwa empewo n’empiso okukendeeza ku buzito oba chest tube.

Okwawula Simple Pneumothorax ku Tension Pneumothorax ku mabbali g’ekitanda¶

Differential diagnosis: Ebirala ebivaako obulumi mu kifuba mu pleuritic¶

Abasawo abasookerwako n’abasawo ab’amangu beetegereza mu nkola entegeke embeera ez’amangu ez’omu kifuba ezikwatagana:

1. ** Obulwadde bw’okuzimba amawuggwe (PE) .: Omusaayi oguzimba okuva mu musuwa omuzito (DVT) okutuuka mu misuwa gy’amawuggwe guleeta obulumi obw’amangu mu kifuba, okussa obubi, n’okusannyalala kw’omutima. Okwawukanako n’ekifuba, amaloboozi g’omukka genkanankana ku njuyi zombi, abalwadde bayinza okusesema omusaayi (okuzimba omusaayi (hemoptysis).), n’ebintu ebiyinza okuvaako akabi mulimu okulongoosebwa gye buvuddeko, okubuuka ennyonyi okumala ebbanga eddene, obutatambula, okufuna olubuto oba kookolo.
2. ** Obulwadde bwa Acute Pericarditis ne Myocarditis: Kireeta obulumi obw’amaanyi mu kifuba mu makkati oba ku kkono nga butangalijja okutuuka ku mugongo gwa trapezius bweyongera okusajjuka ng’ogalamidde ate ne butereera ng’otudde waggulu n’okwesigamira mu maaso, nga waliwo amaloboozi g’omukka aga bulijjo ag’enjuyi zombi.
3. ** Obulwadde bw'omutima era Okusalako omusuwa gw’omusaayi (Aortic Dissection).: Okusannyalala kw’omusuwa gw’omutima kuleeta puleesa ey’amaanyi ey’okunyiga emabega w’omugongo, ate okusalako omusuwa kuleeta obulumi obw’amangu obw’okukutuka nga butangaaza mu mugongo (kikulu nnyo okugaana mu Marfan syndrome, ekitera okusalako ekifuba n’omusuwa).
4. Okukutuka kw’omumwa gwa nnabaana (Boerhaave Syndrome): Okukutuka kw’omumwa gwa nnabaana okuyita mu kisenge oluvannyuma lw’okusesema n’amaanyi, ne kifulumya asidi w’olubuto n’empewo mu kisenge ky’omu lubuto n’ekisenge kya kkono.

Okulabirira nga tonnagenda mu ddwaaliro n‟eddwaliro: By’osuubira okuva mu bajjanjabi abasookerwako ne ED¶

1. Lwaki Okufulumya empewo mu puleesa ennungi (CPAP, BiPAP, oba BVM) Kya bulabe nga Tonnafulumya mpewo¶

Singa omulwadde alina ekifuba ekitannazuulibwa assa, okusiiga CPAP, BiPAP, oba forceful bag-valve-mask (BVM) ventilation kipampa empewo eriko puleesa okuyita mu pleural tear mu kifuba, ne kikyusa okugwa okwangu okufuuka fatal tension pneumothorax. Abaddamu bulijjo bawuliriza amawuggwe gombi (era bakozesa ultrasound ku mabbali g’ekitanda) nga tebannassaako puleesa ennungi ey’emikutu gy’empewo.

2. Okuzuula obulwadde mu ddwaaliro: Okukebera ekifuba ekigolokofu okusinziira ku kukebera ekifuba (POCUS) .¶

• Upright Posteroanterior (PA) Chest X-Ray: Eraga layini enjeru ensongovu (visceral pleural edge) nga tewali bubonero bwa mawuggwe obw’okumpi ku layini. Firimu ezifulumya omukka eza bulijjo tezeetaagisa.
• Point-of-Care Thoracic Ultrasound (POCUS): Ezuula pneumothorax mu sikonda ezitasukka 30 nga ewunyiriza nnyo okusinga supine X-ray. Amawuggwe agagudde galaga obutabaawo kusereba kwa mawuggwe, obutabaawo layini za B-omukira gwa comet, barcode "akabonero ka stratosphere" ku M-mode, n'okuzuula "lung point".

3. Enkola z’obujjanjabi ez’omulembe: Okwetegereza, okusiba, emisuwa gy’ekifuba, ne VATS¶

Ekwatagana n’enkola ya 2023 British Thoracic Society (BTS) Pleural Disease Guideline n’okugezesebwa okw’ensi yonna:

1. Conservative Management (Observation Alone): Ku balwadde abato, abalamu abalina Primary Spontaneous Pneumothorax (PSP) abalina obuzibu obutono oba obutassa era nga balina vitals ezitebenkedde, okwetegereza n’omukka gwa oxygen ogukulukuta ennyo n’okuddamu X-ray mu kifuba mu ssaawa 4 kisobozesa amaziga g’ekifuba okuwona mu butonde awatali mpiso oba tube.
2. Simple Needle Aspiration oba Ambulatory Heimlich Valve: Ku balwadde ba PSP abatassa, abasawo basobola okufuuwa empewo nga bayita mu 14G to 16G cannula (okutuuka ku liita 2.5 [2.6 quarts]) oba okuyingiza ekyezingiramu ambulatory pleural vent (8 Fr catheter with a one-way Heimlich flutter valve) for okugaziya abalwadde abatali balwadde mu nnaku 2 ku 4.
3. Small-Bore Seldinger Intercostal Chest Drain (8 Fr to 14 Fr): Ku Secondary Spontaneous Pneumothorax (SSP), okusiba okulemererwa, oba okugwa kw'obubonero obunene, abasawo bateekamu 8 ku 14 French Seldinger catheter wansi w'okubudamya mu kitundu nga bayita mu "Triangle of Safety" (ensalo pectoralis major, latissimus dorsi, 5^th intercostal space, ne axilla), eyungiddwa ku eccupa y’okusiba wansi w’amazzi.
4. Emergency Needle Decompression (Thoracostomy): Ku tension pneumothorax ne shock, abasawo bayingiza cannula erimu ebituli ebinene (14G, obuwanvu sentimita 4.5 ku 8 [yinsi 1.75 ku 3.25]) mu 2^nd intercostal space midclavicular line oba 4^th oba 5^th intercostal space anterior to the midaxillary line (waggulu ddala ku bbali w’olubavu olwa waggulu), okufulumya puleesa ekwatiddwa amangu ddala.
5. Okulongoosa okuziyiza okuddamu (VATS Bullectomy and Pleurodesis): Ku mpewo okukulukuta okutambula obutasalako (okusukka ennaku 3 ku 5), pneumothorax eddirira, oba emirimu egy’akabi ennyo (abavuzi b’ennyonyi, ababuuka), Video-Assisted Thoracoscopic Surgery (VATS) staples apical blebs (bullectomy) and fuses the pleura okuyita mu abrasion, pleurectomy, oba talc poudrage, okukendeeza ku kuddamu okuva ku 30 okutuuka ku 50 ku buli 100 wansi okutuuka ku 1 ku 5 ku buli 100.

Obugulumivu, okutambula mu nnyonyi, okubuuka mu mazzi, n’okuziyiza oluvannyuma lw’okuwona¶

Omulwadde bw’amala okuwona era omulwadde n’asiibulwa awaka, amateeka amakakali agafuga embeera y’omubiri n’engeri y’obulamu gakuuma obutaddamu kuddamu kulwala:

• Etteeka ly'okulinda okutambula mu nnyonyi mu by'obusuubuzi (BTS & Aerospace Medical Association):
• Olina TOLINA kubuuka na pneumothorax ekola, esigadde, oba etajjanjabiddwa eya sayizi yonna.
• Oluvannyuma lw’okujjanjaba X-ray y’ekifuba okukakasa 100 ku buli 100 complete radiographic resolution (amawuggwe gagaziyiziddwa mu bujjuvu ku bbugwe w’ekifuba nga zero residual air pocket), ekibiina kya British Thoracic Society kiwa amagezi okulinda waakiri ennaku 7 ezijjuvu oluvannyuma lwa X-ray eya bulijjo (era kkampuni z’ennyonyi nnyingi n’ekibiina ekigatta abasawo mu by’omu bbanga bateesa okulinda ennaku 14 oluvannyuma lw’okusalawo mu bujjuvu) nga tonnalinnya nnyonyi ya bya busuubuzi, okukakasa nti fragile visceral pleural scar tegguka nga puleesa ya kabina ekendedde ku buwanvu.
• Okuziyiza okw'enkalakkalira mu kuvuba mu mazzi:
• Olw’okuba okulinnya wadde okuva mu kidiba ekiwugirwamu ekitali kiwanvu mita 10 (fuuti 33) oba okubbira mu nnyanja kikubisaamu emirundi ebiri obuzito bwa ggaasi yenna akwatiddwa era kiyinza okuleeta pulmonary barotrauma and arterial gas embolism (AGE) ekitta, ebyafaayo by’okuzimba ekifuba mu ngeri ey’okwekolako kiziyiza ddala okubuuka mu mazzi mu mazzi n’omukka ogunyigirizibwa okuggyako ng’omuntu oyo ayiseemu bilateral surgical pleurectomy era n’ayita mu specialized high-resolution chest CT ne pulmonary function clearance n’omukugu mu ddagala ly’okubuuka mu mazzi.
• Lekera ddala okunywa ssigala ne vaping:
• Okugenda mu maaso n’okunywa sigala wa taaba, ennyondo z’enjaga/bongs (ezirimu okussa ennyo n’okukola Valsalva maneuvers ezikwata omukka okumala ebbanga eddene), oba sigala/vapes ez’amasannyalaze kye kimu ekisinga obunene ekiyinza okukyusibwamu eky’okuddamu. Okuyimiriza omukka gwonna ogw’omukka n’omukka kikendeeza ku bulabe bw’amawuggwe ag’okubiri okugwa okuva ku ebitundu ebisukka mu 40 okutuuka ku 50 ku buli 100 okutuuka ku bitundu nga 15 ku 20 ku buli 100.
• Weewale okunyigirizibwa ennyo, ebikozesebwa mu mpewo, n'emizannyo egy'okukwatagana okumala wiiki 2 ku 4:
• Linda okutuusa ng’owonye mu bujjuvu mu by’okukuba ebifaananyi n’okulongoosebwa okuva ew’omusawo wo ow’amawuggwe nga tonnadda mu kusitula buzito buzito (wewale okusitula Valsalva okukwata omukka), okukuba ebivuga eby’ekikomo oba eby’empewo ebiziyiza ennyo, oba okwetaba mu mizannyo egy’okukwatagana.

Ennamba z’embeera ez’amangu mu bitundu n’ebiragiro by’ebitongole¶

• United States ne Canada: Kuba 911 amangu ddala ku bulumi obw’amangu mu kifuba n’okussa obubi. Abajjanjabi abasookerwako nga tebannagenda mu ddwaaliro bagoberera American Heart Association (AHA) ne Prehospital Trauma Life Support (PHTLS) / National Association of EMS Physicians (NAEMSP) ebiragiro ebikwata ku kugaba oxygen atambula ennyo, pulse oximetry, n’okulongoosa empiso mu bwangu (2^nd intercostal space midclavicular line oba 4^th/5^th intercostal space anterior axillary line) singa tension physiology ekulaakulana. Enzirukanya y’eddwaliro egoberera enkola ya American Thoracic Society (ATS) ne American College of Chest Physicians (CHEST) ebiragiro.
• United Kingdom: Kuba 999 okufuna ambyulensi ey’amangu (okulumwa ennyo mu kifuba nga tossa bulijjo kuba ssimu ya 999). Okulabirira mu malwaliro kugoberera omutindo gwa British Thoracic Society (BTS) 2023 Guideline for Pleural Disease ne NICE, ezifuga enzirukanya ey’obukuumi, emikutu gy’omukka egy’omu kifuba egy’okutambula ebweru, n’okufulumya amazzi mu kifuba aga Seldinger small-bore.
• Omukago gwa Bulaaya: Kuba 112 mu mawanga gonna agali mu mukago gwa EU. Ttiimu z’amalwaliro zigoberera enkola ya European Respiratory Society (ERS) task force clinical practice guidelines ku primary ne secondary spontaneous pneumothorax, nga bakozesa bedside thoracic ultrasound, digital chest drainage systems, n’okwebuuza ku VATS nga bukyali.
• Australia ne New Zealand: Kuba 000 mu Australia oba 111 mu New Zealand. Empeereza ya ambyulensi n’ebitongole by’abalwadde ab’amangu bigoberera Thoracic Society of Australia and New Zealand (TSANZ) ne Australian and New Zealand Committee on Resuscitation (ANZCOR) ebiragiro, nga birimu amagezi okuva mu kugezesebwa okw’amaanyi okwa ANZ multi-center conservative vs. interventional PSP trial.
• Buyindi ne Asia-Pacific: Kuba 112 mu Buyindi, 995 mu Singapore, 119 mu Japan ne South Korea, oba 999 mu Hong Kong ne Malaysia. Saba ambyulensi eya Advanced Life Support (ALS) erimu omukka gwa oxygen era otegeeze ekitongole ky’abalwadde ab’amangu ekifuna okwetegekera okukuba ebifaananyi mu kifuba nga yeegolodde n’okukendeeza ku puluru.

Ebibuuzo ebitera okubuuzibwa¶

Lwaki abavubuka abawanvu era abagonvu abali mu myaka gyabwe egy’obutiini n’amakumi abiri batera nnyo okugwa amawuggwe mu ngeri ey’okwekolako?¶

Mu kiseera ky’okukula amangu kw’abavubuka, ekituli ekiwanvu era ekifunda mu kifuba kikola ekiwujjo ekiwanvu eky’amaanyi ag’ekisikirize okuva waggulu ku mawuggwe okutuuka wansi. Ensawo z’empewo (alveoli) eziri ku ntikko yennyini ey’amawuggwe zifuna puleesa ey’amaanyi ennyo ey’okugolola embi okusinga amawuggwe amalala, ekivaako obuwuzi obutonotono obulinga ebizimba obutono obuyitibwa subpleural blebs okukola waggulu ku bitundu eby’okungulu. Singa ekimu ku bizimba bino eby’oku ntikko ebirina bbugwe omugonvu kikutuka (naddala nga kinafuye olw’okuzimba kw’emikutu emitono okuva mu kunywa sigala oba okufuuwa omukka), empewo ekulukuta mu kifo ky’omusuwa ekya puleesa embi n’egwa amawuggwe ne bwe kiba nga kitudde.

Oluvannyuma lw’ekiseera ki ng’amawuggwe agagudde gawonye, ​​tekiba kya bulabe okubuuka mu nnyonyi ey’ebyobusuubuzi?¶

Tolina kulinnya nnyonyi ng’ekifuba kyonna ekisigaddewo kikyaliwo ku X-ray y’ekifuba, kubanga puleesa y’obugulumivu mu kabina ereetera empewo y’ekifuba ekwatiddwa okugaziwa ebitundu 25 ku 38 ku buli 100. Okusinziira ku kibiina ekigatta abasawo b’omu kifuba ekya British Thoracic Society (BTS), olina okulinda waakiri ennaku 7 ezijjuvu oluvannyuma lw’okukubwa X-ray y’ekifuba okugoberera okukakasa nti obulwadde bw’ekifuba buweddewo ddala ebitundu 100 ku 100 (era kkampuni nnyingi ez’ennyonyi n’ekibiina ekigatta abasawo mu by’omu bwengula byetaaga okulinda ennaku 14 oluvannyuma lw’okugonjoolwa mu bujjuvu mu kukuba ebifaananyi) nga tonnabuuka nnyonyi.

Nsobola okuddamu okubuuka mu mazzi (scuba dive) oluvannyuma lw’okulwala ekifuba (spontaneous pneumothorax)?¶

Mu kibiina kya British Thoracic Society, Divers Alert Network (DAN), n’ebiragiro by’ensi yonna ebikwata ku ddagala ly’okubuuka mu mazzi, obulwadde bw’ekifuba obw’olubeerera obw’okwekolako buba buggyawo ebisaanyizo eby’olubeerera okuva mu kubuuka mu mazzi n’empewo enyigirizibwa, ne bwe kiba nti amawuggwe gawonye ddala era ne bwe gaba nga gamaze okuwona talc oba abrasion pleurodesis eya bulijjo. Enkyukakyuka za puleesa ezisukkiridde wansi w’amazzi zisobola okukutuka ebiwujjo ebitonotono mu buli mawuggwe ne zigaziya empewo ekwatiddwa ebitundu 200 ku 400 ku buli 100 mu kiseera ky’okulinnya, ne kireeta okusika omuguwa okutta nga tennatuuka kungulu; abantu bokka abatatera kulongoosebwa nga balongooseddwa enseke z’amawuggwe mu njuyi zombi era nga balina CT scans eza bulijjo ddala ez’obulungi obw’amaanyi n’okukeberebwa enkola y’amawuggwe be balowoozebwako okukkirizibwa omusawo akola ku by’okubuuka mu mazzi.

Lwaki obulumi obw’amaanyi mu kifuba bwatandika okutereera ku lunaku olwokubiri wadde ng’omusawo yagamba nti amawuggwe gange gakyagudde?¶

Empewo bw’esooka okukulukuta mu kisenge ky’ekifuba n’eggyako amawuggwe okuva ku bbugwe w’ekifuba, egolola n’okunyiiza ebiwuzi ebiruma mu kifuba eky’omu maaso, ekivaako obulumi obw’amaanyi obw’okufumita buli lw’ossa. Amawuggwe bwe gamala okufulumya omukka okutuuka mu mbeera etali ya kukyukakyuka oluvannyuma lw’essaawa 12 ku 24, okukutuka okukola n’okukyukakyuka kwa puleesa kukoma, n’olwekyo obulumi obw’amaanyi butera okuggwaawo ne bufuuka obulumi obutono oba okunywezebwa okutono wadde ng’amawuggwe gasigala nga gagudde ebitundu 30 ku 60 ku buli 100. Tolowoozangako nti amawuggwe agaagudde gawonye olw’okuba obulumi obw’okufumita mu kusooka bukendedde.

Catamenial pneumothorax kye ki era lwaki kibaawo mu nsonga?¶

Catamenial pneumothorax ye mawuggwe agaddamu okugwa nga gabaawo mu bakyala abali mu myaka egy’okuzaala mu ssaawa 24 nga tebannaba kutandika kugenda mu nsonga okutuuka ku ssaawa 72, nga gakosa amawuggwe aga ddyo mu bitundu ebisukka mu 90 ku buli 100. Kiva ku bulwadde bwa ‘thoracic endometriosis’ (nga microscopic implants of uterine lining tissue we zituula ku diaphragm eya ddyo ne visceral pleura) nga zigatta wamu n’obutuli obutonotono obuzaalibwa (fenestrations) mu diaphragm obusobozesa empewo n’ebitundu by’omu lubuto okuyingira mu kifuba ng’oli mu nsonga. Omukyala yenna afuna obulumi mu kifuba oba amawuggwe agagwa okwetoloola ensonga ze alina okutegeeza omusawo we ow’amawuggwe n’abakyala so targeted VATS diaphragmatic repair and hormonal therapy can prevent relapses buli mwezi.

Bulijjo okuzimba ekifuba mu ngeri eyeetongodde kyetaagisa okulongoosa ekifuba ekiruma?¶

Nedda. Ne bwe kiba kyetaagisa okufulumya amazzi, abasawo leero bakozesa ekyuma ekikuba amangu empiso, ekyuma ekiyambala eky’engalo ekitambula mu kkubo erimu ekikusobozesa okudda eka ku lunaku lwe lumu, oba ekyuma ekigonvu eky’ekkalaamu ekigonvu (8 ku 14 eky’Olufaransa) ekiteekebwa wansi w’eddagala eriwunyiriza mu kitundu okusinga ekyuma ekinene eky’okulongoosa.

Ekitabo kino kiwa amawulire agakwata ku kusomesa mu bwangu era tekidda mu kifo ky’obujjanjabi obw’ekikugu oba okuzuula obulwadde. Olw’okuba obulumi obw’amaanyi mu kifuba n’okusannyalala bisobola okugenda mu maaso amangu okutuuka ku kusannyalala okuyinza okutta obulamu oba okusiba omutima, tusaba nnyo okukola omusomo ogukakasibwa ogw’obujjanjabi obusookerwako n’okukola CPR okuva mu Red Cross, St John Ambulance, oba omutendesi ow’amangu ow’omu kitundu akkirizibwa.

Ebiragiro ebikwatagana nabyo¶

• Tension pneumothorax n'okunuuna ekiwundu mu kifuba obujjanjabi obusookerwako
• Flail ekifuba, okumenya embiriizi, n’okulumwa mu kifuba okutali kwa maanyi
• Obulwadde bw’okuzimba amawuggwe n’okuzimba emisuwa emiwanvu (DVT) .
• Pericarditis, myocarditis, n’obulumi mu kifuba oluvannyuma lw’akawuka bendera emmyufu
• Asthma attack obujjanjabi obusookerwako obw'amangu

Ensonda n’obulagirizi obutongole¶

• British Thoracic Society (BTS, United Kingdom): British Thoracic Society Guideline for Pleural Disease (2023): Enkola ezesigamiziddwa ku bujulizi ez’okuddukanya obulungi, emikutu gy’empewo egy’okutambula, okufulumya empiso, okufulumya amazzi mu kifuba kya Seldinger, VATS pleurodesis, ebiseera by’okulinda okutambula mu nnyonyi, n’okuziyiza okubbira mu mazzi.
• European Respiratory Society (ERS): Ekiwandiiko ky’akakiiko ka ERS ku bulwadde bwa Primary Spontaneous Pneumothorax: Okuzuula n’okuddukanya ebitundu ebisooka n’ebiddirira.
• American Thoracic Society (ATS) ne American College of Chest Physicians (CHEST, Amerika): Ekiwandiiko ky’okukkaanya ku bulwadde bw’ekifuba obw’okwekolako ne New England Journal of Medicine Conservative versus Interventional Treatment for Primary Spontaneous Pneumothorax Trial (Brown et al., ANZ).
• Aerospace Medical Association (AsMA) ne International Air Transport Association (IATA): Ebiragiro by’abasawo ku ntambula y’ennyonyi: Okussa obulungi okubuuka oluvannyuma lw’okulongoosebwa ekifuba n’ekifuba.
• Obuyambi bw’obulamu bw’obuvune nga tebannaba kujjanjabibwa (PHTLS) n’ekibiina ekigatta omutima mu Amerika (AHA): Okuwagira obulamu bw’emisuwa n’emisuwa mu ngeri ey’omulembe (ACLS) Okutegeera n’okukendeeza ku kunyigirizibwa kw’okusannyalala okuva ku Tension Pneumothorax.