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Spontaneous Pneumothorax, Collapsed Lung Symptoms, uye Pleuritic Chest Pain

Nhamba dze emergency dzinosiyana nenyika. Iri peji rinoshandisa 911, nhamba yeUnited States neCanada. Dzimwe nyika dzakawanda dzinoshandisa 112, 999, kana imwe nhamba. Tsvaga nhamba yenyika yako.

Pneumothorax inongoerekana yavapo (inowanzonzi mapapu akaputsika) inoitika apo mweya unobuda mumapapu uye wovharirwa mukati mepleural space, mhango yakatetepa-yakazora mvura iri pakati pekunze kwemapapu nemukati memadziro echipfuva. Kusiyana nekurwadziwa kwakadonha bapu rinokonzerwa ne kutyoka mbabvu kana kukuvara kwechipfuva kana a ronda rechipfuva rinopinda, pneumothorax inongoerekana yaitika pakuzorora pasina kana kukanganiswa kwemuviri. Zvinokonzera kamwe kamwe, zvakapinza, kubaya-divi rimwe divi kurwadziwa kwechipfuva kunowedzera nekufema kwese (pleuritic chest pain) uye kupfupika kwekufema. Kana iwe uchifungidzira kuti mapapu akadonha, fonera nhamba yako yepano emergency kuburikidza neyedu nhamba dze emergency dhairekitori ipapo uye chengetedza munhu akagara akati twasu uye akanyarara zvachose, sezvo chero mapapu akadonha anogona kudzika kusvika panjodzi yehupenyu pneumothorax kana kutevedzera a pulmonary embolism kana chirwere chemoyo.

Ita izvi ikozvino

  1. **Fonera nhamba yako ye emergency emergency nekukasika **: Dial 911 muUnited States neCanada, 112 muEuropean Union yose, 999 muUnited Kingdom, 000 muAustralia, kana tarisa nyika yedu nhamba dze emergency list. Udza anotumira kuti murwere ane kamwe kamwe, akapinza rimwe divi pleuritic marwadzo muchipfuva uye kupfupika kwekufema neanofungidzirwa kudonha mapapu (pneumothorax).
  2. **Isa munhu wacho munzvimbo yakagadzikana yakatwasuka kana semi-yakatwasuka (nzvimbo yaFowler) kana kuzembera zvishoma kudivi rinorwadza **: Kugara wakatwasuka pane 45-degree kusvika 90-degree angle kunokwevera nhengo dzedumbu pasi negiravhiti, zvichipa mapapu asina kukanganiswa kamuri huru yekuwedzera. Usambomanikidzira murwere anofemerwa nechipfuva kuti arare pasi nemanhede.
  3. Mira kushingaira kwese kwemuviri, kufamba, kukosora, kana kusveta (Valsalva maneuvers): Usarega munhu wacho achidzika masitepisi kuenda kuamburenzi, kutakura mabhegi, kusimudza zvinhu, kana kuridza mhino nesimba. Kufema kwese kwesimba, kukosora, kana kunetsa kweValsalva kunofambisa mweya wakawanda kuburikidza nekuputika kwepleural bleb kupinda mugomba rechipfuva uye kunomhanyisa kudonha kwemapapu.
  4. Sunungura hembe dzakasimba pachipfuva, muhuro, nemuchiuno uye vadzikamise kufema kwavo: Vhura makora, mabhandi akasununguka kana mabhuroka akasimba, uye kufema kunononoka, kudzika, kudzikama. Kutya-kunotyaira kwakadzika kufemera pamusoro kunowedzera pleural pressure swings uye kunowedzera marwadzo ekubaya.
  5. Ipa okisijeni yekuwedzera kana yakadzidziswa uye yakashongedzerwa: Kana silinda yeokisijeni yechimbichimbi ine mask isingadzokeri inowanika panzvimbo yebasa, dive boat, kana kiriniki, shandisa okisijeni yepamusoro pa 10 kusvika 15 litres paminiti (kunze kwekunge murwere aziva kuchengetwa kwecarbon dioxide kubva kuCOPD yakaoma, kusvika 9 chinangwa che28 percent* yasvika kuongorora ropa gasi). Okisijeni yakakwira inogadzirisa okisijeni yeropa yakaderera (hypoxemia) uye inomhanyisa kutorwazve kweakavharirwa pleural nitrogen nechikamu chechina.
  6. Ramba uchitarisa mireza matsvuku eTension Pneumothorax: Tarisa mutsipa wemunhu, miromo, kurova kwemwoyo, uye kusvinura kwepfungwa kwega kwega maminitsi maviri. Kana dzikava yakanyanyisa cyanotic (blue miromo), kuvhiringidzika, dzungu, hypotensive, kufema zvakanyanya, kana kukura mitsipa yemutsipa yakanyunguduka, taurira vanokurumidza kutumira murwere kuti murwere ari kuparara kuita anofungidzirwa ** tension pneumothorax ** inoda pakarepo paramedic decompression.
  7. Kurambidza kufamba kwese nendege, mota dzemakomo, uye scuba diving: Kunyange kana kurwadziwa kwechipfuva kuchiita kunge kwakadzikama uye kuchigadziriswa, munhu ane pneumothorax isina kurapwa kana isina kusimbiswa haafanire kukwira ndege, kutyaira nepamusoro pemakomo marefu, kana kupinda mumvura kuti anyure **, sezvo kudzvanywa kunodzorwa neMutemo waBoyle kuchawedzera mhepo yakavharwa yechipfuva.

Usafe Wabhururuka, Kukwira Kumusoro, kana Scuba Dive uine Inofungidzirwa Pleuritic Chest Pain

Zvinoenderana ne ** Mutemo waBoyle (P1 x V1 = P2 x V2), vhoriyamu yegasi rakavharirwa inopindirana neyakakomberedza kumanikidzwa kwemhepo. Mukati mendege yekutengeserana yakamanikidzwa kusvika pakakwirira kabhini1,800 kusvika 2,400 metres (6,000 kusvika 8,000 tsoka)**, homwe yemhepo yakavharirwa mukati mepleural cavity inowedzera ne 25 kusvika 38 percent, ichipwanya pneumothorax yakagadzikana muchikamu chepfu* kana pneumothorax inouraya* nzvimbo iri kure. Scuba diving inotonyanya kuuraya: kana munyuchi achifema mweya wakamanikidzwa pakadzika kana kuti akasangana nekungoerekana bleb kuputika pasi pemvura, kukwira kumusoro kunoita kuti mhepo yakavharirwa pleural iwedzere ne ** 200 kusvika 400 muzana **, kubvarura mapapu uye kumanikidza mwoyo usati wasvika muchikepe. British Thoracic Society (BTS) uye Aerospace Medical Association nhungamiro inorambidza zvachose kufamba nendege kutozosvikira **7 kusvika 14 mazuva mushure mekuzara kweradiographic resolution ** yepneumothorax, uye inorambidza zvachose scuba diving kunze kwekunge yarapwa nebilateral surgical pleurectomy.

Muti wechisarudzo: Kamwe kamwe-sided pleuritic chest pain uye pneumothorax triage

flowchart TD
    Start["Kamwe-kamwe Yakapinza Rimwe-Sided Chest Pain (Yakanyanya Kufemerwa) uye Acute Kupfupika Kwekufema (Hapana Chest Trauma)"] --> TensionCheck{"Pane Tension Pneumothorax Red Flags iripo here? 1. Kunyanya nzara yemhepo kana kusakwanisa kutaura 2. Miromo yebhuruu (cyanosis), SpO2 pasi pe90% 3. Kukurumidza kupera simba (kupfuura 120 bpm), hypotension, kana syncope 4. Mitsipa yemutsipa yakatsauka kana mhepo yakatsauka 5. Murwere ane COPD, asima yakaoma, kana kuti positive-pressure venti."}

    TensionCheck -->|"EHE: Hupenyu Hwekukurumidza Kutyisidzirwa"| TensionProtocol["SUSPECTED TENSION PNEUMOTHORAX OR SECONDARY SPONTANEOUS PNEUMOTHORAX: 1. Dana 911 / 112 / 999 STAT uye utaure Suspected Tension Pneumothorax 2. Chengetedza murwere akagara akatwasuka (45 kusvika 90 degrees) uye zvachose 3. (52 12 L - 10 mhepo inoyerera; 88 kusvika 92% chinangwa kana COPD yakaoma) 4. Usamboshandisa CPAP, BiPAP, kana kumanikidzira bhegi-vhavha-mask ventilation pamberi pechipfuva mhepo 5. Paramedic pakarepo tsono thoracostomy inoteverwa nechipatara chipfuva tube kuiswa."]

    TensionCheck -->|"HAPANA: Hemodynamically kugadzikana, kutaura mitsara yakazara, yakajairika pulse"| RiskProfile{"Ongorora Nhoroondo Yenjodzi Yemurwere: Yepuraimari (PSP) vs Sekondari (SSP) vs Catamenial"}

    RiskProfile -->|"Mudiki (15 kusvika 35 yrs), akareba / mutete kuvaka, anoputa / vaper, hapana chirwere chemapapu"| PSP["Inofungidzirwa Primary Spontaneous Pneumothorax (PSP): Ruptured apical subpleural bleb"]
    RiskProfile -->|"Zera rinopfuura makore makumi mashanu, KANA nhoroondo yeCOPD, emphysema, asima, cystic fibrosis, Marfan"| SSP["Inofungidzirwa Sekondari Spontaneous Pneumothorax (SSP): Lower pulmonary reserve uye njodzi yakakura yekukurumidza kupera"]
    RiskProfile -->|"Inoitika mukati maawa makumi manomwe nemaviri isati yatanga kana mushure mekutanga kwekuenda kumwedzi"| Catamenial["Inofungidzirwa Catamenial / Thoracic Endometriosis Pneumothorax: Kazhinji kurudyi-kurutivi (kupfuura 90%)."]

    PSP --> HospitalEval["Kutakura Munzvimbo Yakagara kuenda kuchipatara ED (Usafambe kana Kuedza): Simbisa ukuru kuburikidza neUpright Inspiration Chest X-Ray, Thoracic Ultrasound (isipo mapapu ekutsvedza), kana CT"]
    SSP --> HospitalEval
    Catamenial --> HospitalEval

    HospitalEval --> SizeBranch{"Kuongororwa Kwechipatara Nehukuru uye Zviratidzo (BTS / ATS / ERS Mirayiridzo)"}

    SizeBranch -->|"Diki PSP (pasi pe2 cm rim pa hilum) UYE kushoma kana kusafema"| Conservative["Conservative Observation + High-Flow Oxygen Therapy: Rebsorbs pa 1.25% kusvika 2% pazuva (4x inokurumidza pa-high-flow O2) Dzokorora X-ray mu4 kusvika kumaawa 6, wozotevera kunze kwekutevera nechisimba NO FLYING mutemo."]
    SizeBranch -->|"Huru PSP (2 cm rimu kana kuti huru) KANA Kufema KANA Chero Chechipiri Pneumothorax (SSP)"| Intervention["Active Pleural Decompression: - Nyore Yetsono Aspiration (14G kusvika 16G cannula) KANA Ambulatory Heimlich Valve Chishandiso - Diki-Bore Seldinger Chest Tube (8 kusvika 14 Fr) yakabatana nechisimbiso chepasi pemvura - VATS pleurodesis kana ichiramba ichidonhedza mweya (kupfuura 3 kusvika kumazuva mashanu, hunyanzvi hwemazuva mashanu),"]

Pathophysiology: Mapupu anodonha sei pasina kukuvara kwechipfuva

Muchipfuva chine utano, nzvimbo yekunze yemapapu (visceral pleura) uye madziro emukati membabvu (parietal pleura) anonamatira pamwe chete mufirimu nhete yepleural fluid (10 kusvika 20 milliliters [0.3 kusvika 0.7 fluid ounces]). Nekuda kwekuti mapapu erastic anogara achidzokera mukati ukuwo mbabvu ichidhonzera kunze, nzvimbo iri pakati pema membranes maviri aya inochengetedza inogara sub-atmospheric (negative) intrapleural pressure ye -3 kusvika -5 cmH2O pakuzorora, ichidonha kusvika -8 kusvika -10 cmH2O panguva yekufema kwakadzika. Uku kusveta kwevacuum kusina kunaka kunoita kuti masaga emhepo (alveoli) apinzwe mbabvu.

1. Apical Blebs, Bullae, uye Kurasikirwa Negative Pleural Suction

Madiki madiki-akaita semhepo masaga anonzi ** subpleural blebs ** (pasi pe 1 kusvika 2 centimita [0.4 kusvika 0.8 inches] muhupamhi, mukati me visceral pleura) kana yakakura ** emphysematous bullae ** (inopfuura 1 kusvika 2 centimita, inoumbwa nekuparadzwa kwealveolar pamusoro**) inokura pamusoro pemadziro** lobes.

Simba rinokwevera pasi rinokwevera hwaro hunorema hwemapapu kudzika kudiaphragm. Mumunhu ane chifuva chakareba, chakamanikana (an ectomorphic build), kureba kwakatwasuka kwethorax kunogadzira mawere pleural pressure gradient (0.25 cmH2O per centimeter of lung height). Iyo alveoli iri kumusoro chaiko kwemapapu inosangana nekusimba kwakasimba kwakashata distening traction pressure pane alveoli pazasi, ichitwasanudza apical tissue kusvika matete-walled subpleural blebs aumba.

Kana apical bleb rikaputika kuburikidza ne visceral pleura, kuvhurika kunoita pakati penzira dzemhepo neiyo negative-pressure pleural cavity: 1. Mhepo inomhanya ichibuda mumapapu ichipinda munzvimbo yepleural kusvika iyo isina kunaka vacuum yarasika uye intrapleural pressure yakaenzana nemhepo yemuchadenga (0 cmH2O). 2. Yakabviswa vacuum tether yekunze, mapapu anorarika anodzokera mukati akananga kumudzi wepakati (hilum), achidonha zvishoma kana zvachose. 3. Iyo yakaputsika yemapapu tishu inomira kutora chikamu mukutsinhana kwegasi, ichigadzira ** ventilation-perfusion (V / Q) mismatch ** uye kurudyi-kuruboshwe shunt kusvika ** hypoxic pulmonary vasoconstriction ** inodzosera kuyerera kweropa kumapapu ane hutano.

2. Sei Oxygen Inoyerera Yakakwira Ichimhanyisa Kudzora ne400 Percent (Nitrogen Washout)

Zvinenge ** 78 muzana yegasi rakavharirwa rinosanganisira nitrogen (N2) **, gasi inert inonyungudika zvisina kunaka muropa. Pasi pemhepo yekufema-mhepo, yakavharwa pneumothorax yakavharwa inopinda mukati mepleural capillaries chete ** 1.25 kusvika 2.2 muzana yehemithorax volume pamaawa makumi maviri nemana ** (zvinoreva kuparara kwe30 muzana kunotora mavhiki maviri kusvika ku3 kuti achene oga).

Apo varapi vehutano kana vanachiremba vanokurumidzira vakashandisa ** high-flow supplemental oxygen (10 kusvika ku15 litres paminiti kuburikidza ne-non-rebreather mask) **, oksijeni yakafuridzirwa inosuka nitrogen kubva pakutenderera kweropa reropa, ichideredza chikamu che nitrogen mu pleural capillaries kubva kunenge 573 mmHg kuenda ku zero apo capillary tishu inodya. Izvi zvinogadzira mawere ** partial pressure diffusion gradient ** pakati pe nitrogen-rich pleural pocket uye nitrogen-depleted capillary blood, kudhonza gasi rakavharirwa kunze kwepleural space ** nekasere nekukurumidza ** (kusvika ** 4 kusvika ku8 muzana yehemithorax volume pazuva **).

Kufananidza iwo mana emakiriniki emhando dzepamhepo pneumothorax

Kunzwisisa kuti ndechipi chikamu chemurwere chinowira mumadhairekitori, nekuti mumhanyi wechidiki ane hutano ane 25% kudonha anogona kuratidzika akasununguka pakuzorora, nepo ane makore makumi matanhatu neshanu ane emphysema uye kudonha kwegumi muzana anogona kukurumidza kubatwa ne hypoxic kusungwa.

Clinical Category Yakajairika Murwere Profile & Chinokonzera Chikonzero Clinical Presentation & Severity Risk Recurrence Rate (Pasina Pleurodesis)
Primary Spontaneous Pneumothorax (PSP) Kuramwa vechidiki vakuru vane makore gumi nemashanu kusvika pamakumi matatu nemashanu vasina chirwere chemapapu chiri pachena. Yakabatana ne ** yakareba, yakaonda kuvaka ** (yechirume-ku-mukadzi reshiyo 3: 1 kusvika 6: 1) uye ** mudzanga, cannabis, kana vape kuputa ** (kusvuta kunowedzera njodzi yePSP ** 9-yakapetwa muvakadzi uye makumi maviri nemaviri muvarume **). Kukurumidza kupinza unilateral kurwadziwa kwechipfuva kunopenya kune ipsilateral pfudzi kana scapula, nekufema-kusvika-pakati-kati kufema kunowanzodzikira mushure memaawa makumi maviri nemana kunyangwe mapapu anoramba akadonha. Kashoma kukonzera tension pneumothorax (pasi pe1 kusvika 2%). ** 30% kusvika 50% mukati memakore 1 kusvika ku4 ** (kusvuta kurega kunoderedza njodzi yekudzokazve inenge hafu).
Secondary Spontaneous Pneumothorax (SSP) Inowanikwa muvarwere (kazhinji ** vane makore makumi mashanu + emakore **) vane ** structural mapapu chirwere **: ** COPD uye bullous emphysema ** (50% kusvika 70% yeSSP), yakaoma ** asthma **, ** cystic fibrosis **, pulmonary fibrosis, kenza yemapapu, tuberculosis, kana * Pneumocystis * Pneumocystis. Kufa kwekukurumidza kukuru: Nekuti mapapu asara akanganisa kuchinjana kwegasi, kunyangwe kudonha kwe10% kusvika 15% kunokonzera yakadzika hypoxemia (SpO2 pasi pe85%), hypercapnia, yakanyanya dyspnea, hypotension, uye tension pneumothorax. ** 40% kusvika 60% **; inoda kupinda muchipatara uye chest tube drainage.
Hereditary Connective Tissue & Cystic Syndromes Varwere vane Marfan syndrome (FBN1 mutation: kureba, minwe mirefu, lens dislocation, aortic root dilation), Vascular Ehlers-Danlos syndrome (vEDS), Birt-Hogg-Dube syndrome (FLCN mutation), Lymphangioleiomyopha- kushaya simba**** kuperevedza kweLymphangioleiomyopha-1* (LAM) kushaya simba* kana kuti LAM) Inowanikwa muvakuru vechidiki uye inogona kuiswa zvisirizvo sePSP kunze kwekunge varapi vakatarisa Marfanoid kana nhoroondo yemhuri. MuMarfan syndrome, kurwadziwa kwechipfuva kunofanirawo kuongororwa acute aortic dissection. ** 50% kusvika 80% ** kunze kwekunge yarapwa neVhidhiyo-Inobatsira Thoracoscopic Surgery (VATS) uye pleurodesis.
Catamenial Pneumothorax (Thoracic Endometriosis) Anorova vakadzi vezera rekubereka (makore makumi maviri nemashanu kusvika makumi mana nemashanu) mumaawa makumi maviri nemana tisati tasvika pamaawa makumi manomwe nemaviri mushure mekutanga kuenda kumwedzi. Inokonzerwa ne endometrial implants pa diaphragm kana pleura uye mhepo ndima kuburikidza nekuberekwa kwe diaphragmatic fenestrations. Kupfuura ** 90% kusvika 95% inoitika kudivi rekurudyi **. Tarisa mazuva ekarenda ezvikamu zvekurwadziwa kwechipfuva zvichienderana nekutevera kumwedzi. **Kupfuura 50% kusvika 70% nemwedzi ** kunze kwekunge varapwa neVATS diaphragmatic repair/pleurodesis uye hormonal suppression.

Kuziva zviratidzo: Kuputsika kusina kuoma vs. Tension Pneumothorax

1. Classic Signs of Simple Spontaneous Pneumothorax

Munopfuura ** 80 muzana yezviitiko **, pneumothorax yekutanga inoitika pakuzorora kwete panguva yekurovedza muviri kukuru: - Kamwe kamwe, kupinza, kubaya unilateral kurwadziwa muchipfuva (Pleuritic Pain): Kufemereka, kukosora, kuseka, kana kumonyorora torso kunokonzera kubata kwakapinza kunomanikidza kufema kupfupi, kudzika ("kutsemuka"). - ** Ipsilateral shoulder-tip kana kumusoro kumashure (scapular) kurwadziwa **: Nemhaka yokuti parietal pleura inovhara pakati diaphragm haina kuvharwa ne ** phrenic nerve (cervical midzi C3, C4, uye C5) **, kushatirwa kubvaumhepo inopukunyuka kunoendeswa kumuro kwepfudzi kune rumwe rutivi. - Kutadza kufema kwakanyanya (Dyspnea): Kubva panzara yemhepo yakapfava pamasitepisi kusvika pakufemereka puzorora. - **Kuoma, kubira, kukosora kusingabereki **: Kunokonzeswa nepleural stretch receptors sezvo mapapu apera. - Subcutaneous emphysema ("Rice Krispies" inotsemuka pasi peganda): Kutsvaga mhepo mukati memediastinum (pneumomediastinum) nemuhuro kunoburitsa kuputika pasi pezvigunwe kana kurira kunorira nekurova kwemoyo (**chiratidzo chaHamman **). - **Kuongorora kwepanyama zvakawanikwa **: Rutivi rwakakanganiswa rwunofamba zvishoma panguva yekufema, inonzwika isina ruzha kana yakabatwa (**hyperresonance to percussion **), uye ine **yakaderedza kana kusavapo kufema kunonzwika ** pa auscultation.

Iyo 24-Awa 'Kupera Kurwadza Kunorwadza' Musungo muVadiki Vakuru

Muvanhu vadiki, vane hutano vane pneumothorax yekutanga, inopinza pleuritic muchipfuva kurwadziwa kazhinji ** kunowedzera mumaawa mashoma ekutanga uye kuderera mushure memaawa makumi maviri nemana **, kunyangwe mapapu anoramba ari 30 kusvika 60 muzana akadonha. Vazhinji vechidiki vechidiki vanokanganisa kurwadziwa uku kuri kupera kwemhasuru yakadhonzwa vokwira ndege kana kutamba mitambo mazuva gare gare. Chero kurwadziwa kwepachipfuva kwedivi rimwe nekukasira kunoda kufungidzira kwechipfuva usati watangazve kuita zvenguva dzose.

2. Kufambira mberi kune Tension Pneumothorax: Iyo One-Way Valve Emergency

A tension pneumothorax inoitika kana chidimbu chepleural chabvaruka chichiita seimwe nzira vharafu: inhalation inosveta mweya kubva mumuti webronchial kupinda mupleural cavity, asi kufema kunovhara chivharo kuti mhepo isakwanise kupukunyuka.

Nekufema kwese, kumanikidza kwakanaka kunovaka mukati mechipfuva (+10 kusvika +20 cmH2O kana kupfuura): 1. Pedzisa ipsilateral lung collapse: Bapu rinenge rabatwa rakapwanyika rakati sandarara pakatarisana nehilum. 2. Kuchinja kwepakati nekutsikirira kwemapapu akatarisana: Kukwira kwesimba kunosunda moyo, mhepo yemhepo (trachea), uye midziyo mikuru ichiyambuka nechepakati kuenda kudivi rine hutano, ichimanikidza mapapu asara. 3. ** Kinking yeVena Cava uye Obstructive Shock **: Positive intrathoracic pressure inosvina ** yepamusoro uye yakaderera vena cava ** kuvhara. Venous kudzokera kuatrium yekurudyi inodonha kusvika zero, kubuda kwemoyo kunodonha mu obstructive shock, uye murwere anotambura Pulseless Electrical Activity (PEA) kusungwa kwemoyo mukati memaminitsi kunze kwekunge yabuda netsono decompression kana chest chubhu.

Kusiyanisa Nyore Pneumothorax kubva kune Tension Pneumothorax padivi pemubhedha

Chiratidzo chekuongorora Isina Kuoma (Iri Nyore) Spontaneous Pneumothorax Tension Pneumothorax (Immediate Life Threat)
Kufema & Kutaura Mild-to-moderate dyspnea; anotaura mitsara yakazara kana chidimbu pakuzorora. **Nzara yemhepo yakanyanyisa, kufemereka, kudikitira zvakanyanya **, kushushikana, kana kusagona kutaura mazwi anopfuura 1 kusvika maviri.
Pulse & Blood Pressure Mild tachycardia (90 kusvika 110 bpm); **kumanikidzwa kweropa kwakajairwa ** (kupfuura 100 mmHg systolic). ** Yakanyanya tachycardia (inopfuura 120 kusvika 140 bpm) ** ipapo bradycardia; ** hypotension (systolic BP pasi pe90 mmHg) **, isina simba kana kusavapo radial pulse.
**Ganda & Oximetry ** Normal ganda ruvara; SpO2 kazhinji 92% kusvika 98% pamhepo yemukamuri. ** Pale, kutonhora, clammy ganda ** ne central cyanosis (blue lips); SpO2 ** pasi pe85% kusvika 90% ** pasinei neokisijeni.
Neck Veins & Trachea Mitsipa yemutsipa yakati sandara kana wakagara wakatwasuka; trachea midline. Distended neck veins (JVD) ugere wakatwasuka; ** trachea yakasuduruka KURE kubva kudivi rakadonha ** (chiratidzo chekunonoka).
**Kuziva ** Yambiro uye yakanangana (GCS 15). Kusagadzikana, kuvhiringika, kana kutsimwaira kubva muuropi hypoxia uye kuvhunduka.

Differential diagnosis: Zvimwe zvikonzero zvepleuritic chest pain

Paramedics uye varapi vekukurumidzira vanonyatso ongorora kuputika kwechipfuva nekukurumidza:

  1. Pulmonary Embolism (PE): Ropa rakagwamba rinofamba kubva mutsinga yakadzika (DVT) kuenda kutsinga dzepulmonary rinokonzera kamwe kamwe kurwadziwa kwechipfuva, dyspnea, uye tachycardia. Kusiyana nepneumothorax, **manzwi ekufema akaenzana kumativi ese **, varwere vanogona kukosora ropa (hemoptysis), uye zvinhu zvine ngozi zvinosanganisira kuvhiyiwa kwemazuva ano, kufamba nendege kwenguva refu, kusafamba zvakanaka, pamuviri, kana kenza.
  2. Acute pericarditis uye myocarditis: Inokonzeresa kurwadza kwepakati kana kuruboshwe kwepleuritic muchipfuva kunopenya kune trapezius ridge iyo ** inowedzera kana wakarara wakarara uye inonatsiridza kana wakagara uye wakazendamira kumberi **, neyakajairwa bilateral mweya inonzwika.
  3. Heart Attack uye Aortic Dissection: Myocardial infarction inokonzera kudzvinya kunorema retrosternal pressure, ukuwo aortic dissection inokonzera kukurumidza kubvarura kurwadziwa kunopenya kumusana (yakakosha kutonga mu ** Marfan syndrome **, iyo inofanotaura kune zvose pneumothorax uye aortic dissection).
  4. Kutsemuka Kwesophageal (Boerhaave Syndrome): Kutsemuka kwegurokuro mushure mekurutsa zvine simba, kuburitsa gastric acid nemhepo mumediastinum uye kuruboshwe pleural cavity.

Pre-chipatara uye kutarisirwa kwechipatara: Chii chekutarisira kubva kune vanobatsira varwere uye ED

1. Nei Positive-Pressure Ventilation (CPAP, BiPAP, kana BVM) Iine Ngozi Usati Wabuda

Kana murwere ane pneumothorax isina kuongororwa akafema, kushandisa ** CPAP, BiPAP, kana kuti simba bag-valve-mask (BVM) ventilation ** inopomba mhepo yakamanikidzwa kuburikidza nekuputika kwepleural mubhokisi rechipfuva, kushandura kudonha nyore nyore ** inouraya tension pneumothorax **. Vanopindura vanogara vachikurudzira mapapu ese (uye shandisa ultrasound yepadivi pemubhedha) vasati vashandisa mhepo yakanaka.

2. Kuongororwa Kwechipatara: Upright Chest X-Ray vs. Thoracic Ultrasound (POCUS)

  • Upright Posteroanterior (PA) Chest X-Ray: Inoratidza mutsara wakapinza muchena (visceral pleural edge) ine mapapu asipo ari padivi pemutsetse. Mafirimu enguva dzose anopera simba haadiwi.
  • Point-of-Care Thoracic Ultrasound (POCUS): Inoona pneumothorax pasi pemasekonzi makumi matatu nekunzwa kwakanyanya kudarika supine X-ray. Bapu rakadonha rinoratidza **kusavapo kwemapapu kutsvedza **, kusavapo kwecomet-tail B-lines, barcode "stratosphere sign" paM-mode, uye diagnostic "lung point".

3. Mazuvano Kurapa Sarudzo: Kucherechedza, Kushuva, Chest Tubes, uye VATS

Yakabatana ne 2023 British Thoracic Society (BTS) Pleural Disease Guideline nemiedzo yepasi rose:

  1. ** Conservative Management (Observation Alone) **: Kune vechidiki, varwere vane utano hwakanaka ** Primary Spontaneous Pneumothorax (PSP) ** vane ** zvishoma kana kuti vasina kufema kufema ** uye zvakagadzikana zvakakosha, kucherechedza nepamusoro-kuyerera kweokisijeni uye kudzokorora chifuva X-ray mumaawa 4 inobvumira pleural misodzi kupora zvakasikwa pasina tsono kana chubhu.
  2. Simple Needle Aspiration or Ambulatory Heimlich Valve: Kuvarwere vePSP vasingafeme, vanachiremba vanogona kusvira mweya kuburikidza ne 14G kusvika 16G cannula (kusvika 2.5 malita [2.6 quarts]) kana kuisa *self-contained ambulatory pleural vent (8 Fr-catheter out expansion valve imwe expansion valve) mazuva maviri kusvika mana.
  3. Small-Bore Seldinger Intercostal Chest Drain (8 Fr kusvika 14 Fr): YeSecondary Spontaneous Pneumothorax (SSP), yakundikana shuwa, kana kudonha kukuru kwechiratidzo, vanachiremba vanoisa 8 kusvika 14 French Seldinger catheter pasi peanesthesia yemo kuburikidza neOdha huru **"Triangle (Triangle) latissimus dorsi, 5th intercostal space, uye axilla), yakabatana ne ** pasi pemvura chisimbiso bhodhoro **.
  4. Emergency Needle Decompression (Thoracostomy): Kutension pneumothorax nekuvhunduka, varapi vanoisa hombe-bore cannula (14G, kureba 4.5 kusvika 8 centimita [1.75 kusvika 3.25 inches]) mu ** 2nd intercostal mitsara* 4 intercostal space* 5 nzvimbo yepakati* kana 5 nzvimbo yepakati* kusvika kumutsara wemidaxillary** (pamusoro pembabvu yepamusoro), uchiburitsa dzvinyiriro yakabatwa nekukasira.
  5. Kuvhiya Kudzivirira Kudzokororwa (VATS Bullectomy uye Pleurodesis): Nekuramba kudonha kwemhepo (kupfuura 3 kusvika kumazuva 5), inodzokororwa pneumothorax, kana hunyanzvi hwenjodzi huru (vatyairi vendege, vakasiyana), **Vhidhiyo-Inobatsirwa Thoracoscopic Surgery (VATS)**blesura*sples kuburikidza ne ** abrasion, pleurectomy, kana talc poudrage **, kuderedza kudzokorora kubva ku ** 30 kusvika ku50 muzana pasi kusvika ku1 kusvika ku5 muzana **.

Mitemo Yekugadzirisa Bhodhoro reChifukidzo chePasi pemvura Chisimbiso cheDrain paBedside

Pakubatsira murwere ari muchipatara ane intercostal chest drain yakabatana ne ** underwater seal bottle : 1. Gara chengeta bhodhoro PASI pechipfuva chemurwere (pasi kana furemu yemubhedha). Kuisimudza pamusoro pechipfuva chepamusoro siphons fluid uye mweya kumashure muchipfuva. 2. Usambofa wakasungirira mvura yemuchipfuva inotubuka. Kubata mweya unobuda mumvura kunoteya mweya muchipfuva uye kunokonzeresa pneumothorax inotyisidzira upenyu**. 3. Chengeta bhodhoro rakati twasu. Kana rikagogodzwa, risimudze ipapo ipapo kuitira kuti mvura ivhare mumvura uye zivisa mukoti.

Altitude, kufamba kwemhepo, scuba diving, uye kudzivirira mushure mekupora

Kana pneumothorax yakangoerekana yapora uye murwere aburitswa kumba, mitemo yakasimba yebarometric nemararamiro inodzivirira kubva pakudzokerazve kunouraya:

  • Kutengesera Kwemhepo Kunomirira Rule (BTS & Aerospace Medical Association):
  • Haufanirwe kubhururuka nepneumothorax inoshanda, yasara, kana isina kurapwa** chero saizi.
  • Kana imwe nguva mushure mekurapwa kwechipfuva X-ray inosimbisa ** 100 muzana yakakwana radiographic resolution ** (mapapu akawedzerwa zvakakwana kumadziro echipfuva ne zero residual air pocket), British Thoracic Society inokurudzira kumirira zvishoma ** mazuva manomwe akazara mushure memazuva ose e-X-ray ** (uye ndege dzakawanda uye Aerospace Medical Association inokurudzira kumirira ** mazuva gumi nemana mushure mokunge vapedza radiographical kubhururuka kwekutengesa *) pleural scar haivhurike kana dzvinyiriro yekabhini inodonha pakukwirira.
  • **Permanent Scuba Diving Restriction **:
  • Nekuti kukwira kubva pakadzika 10-mita (33-foot) dziva rekushambira kana kunyura kwegungwa kunowedzera kaviri huwandu hwechero gasi rakavharirwa uye zvinogona kukonzera kuuraya ** pulmonary barotrauma uye arterial gas embolism (AGE) *, nhoroondo yekuzvimiririra pneumothorax ndeye ** zvachose zvachose munhu akapikiswa nekumanikidzwa kwegasi kunopesana. bilateral surgical pleurectomy uye akapfuura nyanzvi yepamusoro-resolution chest CT uye pulmonary function clearance nenyanzvi yemishonga yekudhivha.
  • ** Rega Kusvuta uye Vaping Zvakakwana **:
  • Kuramba uchiputa fodya yefodya, majoini ecannabis/mabhongi (anosanganisira kufemera pamusoro uye kubata kufema kwenguva refu kweValsalva maneuvers), kana midzanga yemagetsi/mavhapesi ndiye mutyairi mukuru anogona kuchinjika wekudzokorora. Kumisa hutsi hwese hunofemerwa uye mhute kunoderedza njodzi yemapapu echipiri akadonha kubva ** pamusoro pe40 kusvika 50 muzana zvichidzika kusvika pa15 kusvika 20 muzana **.
  • Dzivisa Kuremedza, Zviridzwa zveMhepo, uye Kubata Mitambo Kwemavhiki maviri kusvika mana:
  • Mirira kusvika kuzere radiographic kupora uye kubvumidzwa kubva kune yako pulmonologist usati wadzokera kune inorema weightlifting (rega kufema-kubata Valsalva lifts), kuridza-inodzivirira ndarira kana zviridzwa zvehuni, kana kutora chikamu mumitambo yekusangana.

Nhamba dzenharaunda dzechimbichimbi uye zvirongwa zveagency

  • United States neCanada: Fonera 911 nekukasira nekuda kwekukasira pleuritic kurwadziwa muchipfuva uye kupfupika kwekufema. Pre-hospital paramedics inotevera ** American Heart Association (AHA) ** uye ** Prehospital Trauma Life Support (PHTLS) / National Association of EMS Physicians (NAEMSP) ** mapuroteni epamusoro-kuyerera kweokisijeni administration, pulse oximetry, uye emergency sindano thoracostomy (2nd intercostal space midclavicular line kana 4th / 5 mutsara wepakati) physiology inokura. Kutarisira chipatara kunotevera ** American Thoracic Society (ATS) ** uye ** American College of Chest Physicians (CHEST) ** nhungamiro.
  • United Kingdom: Fonera 999 yeamburenzi yechimbichimbi (kurwadziwa kwechipfuva nekufema kunogara kuchifona 999). Kuchengetwa kwechipatara kunotevera British Thoracic Society (BTS) 2023 Nhungamiro yePleural Disease uye NICE zviyero, zvinotonga kuchengetedzwa kwekuchengetedza, outpatient ambulatory pleural vents, uye Seldinger madiki-akabereka madhini echipfuva.
  • European Union: Dial 112 munyika dzese dziri nhengo dzeEU. Zvikwata zvezvipatara zvinotevera **European Respiratory Society (ERS)**task force clinical practice guidelines for primary and secondary spontaneous pneumothorax, vachishandisa mubhedha thoracic ultrasound, digital chest drainage systems, uye kutanga kweVATS kubvunza.
  • ** Australia neNew Zealand **: Fonera ** 000 ** muAustralia kana ** 111 ** muNew Zealand. Ambulance masevhisi uye madhipatimendi ekukurumidzira anotevera ** Thoracic Society yeAustralia neNew Zealand (TSANZ) ** uye ** Australian neNew Zealand Komiti yeResuscitation (ANZCOR) ** mirayiridzo, ichibatanidza manzwisisiro kubva kuchiratidzo cheANZ multi-center conservative vs. interventional PSP kuedza.
  • India neAsia-Pacific: Dial 112 muIndia, 995 muSingapore, 119 muJapan neSouth Korea, kana 999 muHong Kong neMalaysia. Kumbira Advanced Life Support (ALS) ambulensi ine okisijeni uye zivisa dhipatimendi rinogamuchira rekukurumidzira kuti rigadzirire yakatwasuka chest radiography uye pleural decompression.

Mibvunzo inowanzo bvunzwa

Sei majaya akareba, akaonda ari mumakore ekuyaruka uye makumi maviri ari nyore kuita mapapu anodonha anongoerekana adonha?

Munguva yekukura kwevachiri kuyaruka, mhanza yakareba, yakatetepa yechipfuva inogadzira kukwirisa kwakatwasuka kwegiravhiti kubva pamusoro pemapapu kusvika pasi. Masaga emhepo (alveoli) ari panhongonya chaipo pemapapu anosangana nedzvinyiriro isina kunaka yakatambanudzwa kupfuura mapapu, zvichiita kuti tumapundu tudiki-diki senge subpleural blebs kuti aumbe pamusoro pemarobe epamusoro. Kana imwe yeaya akatetepa-akakomberedzwa apical blisters akatsemuka (kunyanya kana akaneta nekuzvimba kwemhepo kudiki kubva mukuputa kana kuputira), mweya unodonhera munzvimbo isina kunaka-kumanikidza pleural nzvimbo uye inodonha mapapu kunyangwe akagara akanyarara.

Inguva yakadii mushure mekunge mapapu akadonha aporeswa, zvine ngozi here kubhururuka nendege yekutengeserana?

Haufanire kukwira ndege nepo pneumothorax yasara ichiripo paX-ray yepachipfuva, nekuti kukwirira kwekabhini kunoita kuti mweya wakavharirwa muchipfuva uwedzere ne25 kusvika 38 muzana. Maererano neBritish Thoracic Society (BTS), unofanira kumirira mazuva manomwe akazara mushure mekutevera chipfuva X-ray inosimbisa 100 muzana yakakwana kugadziriswa kwepneumothorax (uye ndege dzakawanda uye Aerospace Medical Association inoda kumirira mazuva gumi nemana mushure mekugadzirisa radiographic yakazara) isati yabhururuka.

Ndinogona here kusvetuka dive zvakare mushure mekuita pneumothorax yega?

Pasi peBritish Thoracic Society, Divers Alert Network (DAN), uye nhungamiro yemishonga yekunyudza pasi rose, pneumothorax yakapfuura inogara ichibvisa kubva kuscuba diving nemhepo yakamanikidzwa, kunyangwe mushure mekunge mapapu apora zvachose uye kunyangwe mushure meyakajairwa talc kana abrasion pleurodesis. Kunyanya kudzvinyirirwa kunochinja pasi pemvura kunogona kutsemura ma blebs asingaoneki mumapapu uye kuwedzera mweya wakavharirwa ne200 kusvika 400 muzana panguva yekukwira, zvichikonzera tension inouraya pneumothorax isati yasvika pamusoro; chete vashoma vavhoti vakaitwa bilateral surgical pleurectomy uye vane zvakazara zvakajairika high-resolution CT scans uye mapapu kushanda bvunzo zvinombofungidzirwa kuti zvibvumirwe nachiremba anodhivha.

Sei kurwadziwa kwangu kwechipfuva kwakatanga kunzwa zviri nani pazuva rechipiri kunyange zvazvo chiremba akati mapapu angu achiri kudonha?

Kana mhepo inotanga kubuda mumuromo wepleural uye ichibvisa mapapu kubva pamadziro echipfuva, inotambanudza uye inoshatisa marwadzo muparietal pleura, zvichikonzera kurwadziwa kwakanyanya kwekubaya nekufema kwese. Kana mapapu angopedza kudzika kusvika pakadzikama mushure memaawa gumi nemaviri kusvika makumi maviri nemana, kubvaruka nekumanikidza kunomira, saka marwadzo anopinza anowanzo dzika kusvika mukurwadziwa kwakanyanya kana kusimba kwakapfava kunyangwe mapapu anoramba ari 30 kusvika 60 muzana akadonha. Usambofa wakafunga kuti bapu radonha rapora nekuda kwekuti marwadzo ekutanga ekubaya apera.

Chii chinonzi catamenial pneumothorax uye nei ichiitika panguva yekuenda kumwedzi?

A catamenial pneumothorax imapapu akadonha anowanzoitika muvakadzi vezera rekubereka mukati memaawa makumi maviri nemana vasati vasvika kumaawa makumi manomwe nemaviri mushure mekutanga kwekutevera kwavo, zvichikanganisa mapapu ekurudyi mune zvinopfuura makumi mapfumbamwe muzana zvezviitiko. Inokonzerwa ne thoracic endometriosis (apo maimplants euterine lining tishu anogara kurudyi diaphragm uye visceral pleura) akasanganiswa netumaburi tudiki twekuzvarwa (fenestrations) mudiaphragm inobvumira mweya uye endometrial tissue kupinda mugomba rechipfuva panguva yekutevera. Chero mukadzi anonzwa kurwadziwa muchipfuva kana mapapu akadonha panguva yekutevera kwake anofanira kuzivisa chiremba wake wepulmonologist uye gynecologist saka anonangwa neVATS diaphragmatic kugadzirisa uye hormonal therapy inogona kudzivirira kudzokazve pamwedzi.

Ko pneumothorax inogara ichida kuvhiyiwa chubhu yechipfuva inorwadza here?

Kwete Mazuva ano makiriniki ekuedzwa uye 2023 British Thoracic Society mazano anoratidza kuti kana iwe uri muduku, kana uine hutano (Primary Spontaneous Pneumothorax), uye kwete kunyanya kufema, mapapu ako akaputsika anogona kazhinji kutarisirwa nekuchengetedza nekucherechedza uye kuyerera kweokisijeni yepamusoro chete pasina tsono kana chubhu. Kunyange kana mvura ichidiwa, vanachiremba nhasi vanoshandisa kana tsono inokurumidza kuvavarira, chinopfekwa chakakura semuchindwe chevharuvhu chinokutendera kuti uende kumba zuva rimwe chetero, kana penzura-tete flexible catheter (8 kusvika 14 French) inoiswa pasi pemushonga wemuno wemuno kwete chubhu hombe yekuvhiya.

*Nhungamiro iyi inopa ruzivo rwedzidzo yekukurumidzira uye haitsivi rubatsiro rwekurapa kana kuongororwa. Nekuti kurwadziwa kwakanyanya muchipfuva uye kushushikana kwekufema kunogona kufambira mberi nekukurumidza kusvika kuhupenyu hwekutya kana kusungwa kwemoyo, isu tinokurudzira zvakasimba kutora yakasimbiswa maoko-parubatsiro rwekutanga uye CPR kosi kubva kuRed Cross, St John Ambulance, kana anotenderwa anodzidziswa echimbichimbi munharaunda.

Mazano anoenderana

Nzvimbo uye nhungamiro yepamutemo

  • British Thoracic Society (BTS, United Kingdom): British Thoracic Society Guideline for Pleural Disease (2023): Evidence-based protocols for conservative management, ambulatory pleural vents, tsono aspiration, Seldinger chest drainage, VATS pleurodesis, nguva dzekumirira kufamba nemhepo, uye zvirambidzo zvekunyura.
  • European Respiratory Society (ERS): *ERS Task Force Statement paPrimary Spontaneous Pneumothorax: Kuongororwa uye Kutungamirirwa kweZvikamu Zvekutanga uye Zvekare *.
  • American Thoracic Society (ATS) uye American College of Chest Physicians (CHEST, United States): Kutungamirirwa kweSpontaneous Pneumothorax Consensus Statement uye New England Journal of Medicine Conservative versus Interventional Treatment for Primary Spontaneous Pneumothorax Trial (Brown et al., ANZ)
  • Aerospace Medical Association (AsMA) uye International Air Transport Association (IATA): Mirayiridzo Yezvekurapa Yekufamba Kwendege: Kufema Kusimba Kubhururuka Mushure mePneumothorax uye Thoracic Surgery.
  • Prehospital Trauma Life Support (PHTLS) uye American Heart Association (AHA): Advanced Cardiovascular Life Support (ACLS) Kuzivikanwa uye Kuora mwoyo kweObstructive Shock kubva Tension Pneumothorax.