••••• login ELINGUE Contatti: Tel. 02-36553040
              Email:
   

Selettore risorse


     IL Metodo  |  Grammatica  |  Inglese con noi  |  Multiblog  |  INSEGNARE AGLI ADULTI  |  INSEGNARE AI BAMBINI  |  AudioBooks  |  RISORSE SFiziosE  |  Articoli  |  Tips  | testi pAralleli  |  VIDEO SOTTOTITOLATI

   AREA SHOP  RIVISTA ENGLISH4LIFE  | CORS0 20 ORE DI INGLESE |  CORSO 20 ORE DI SPAGNOLO | CORSO 20 ORE DI TEDESCO  | CORSO 20 ORE DI FRANCESE  | CORSO 20 ORE DI RUSSO 


 

WIKIBOOKS
DISPONIBILI
•••••••••

ART
- Great Painters
BUSINESS&LAW
- Accounting
- Fundamentals of Law
- Marketing
- Shorthand
CARS
- Concept Cars
GAMES&SPORT
- Videogames
- The World of Sports

COMPUTER TECHNOLOGY
- Blogs
- Free Software
- Google
- My Computer

- PHP Language and Applications
- Wikipedia
- Windows Vista

EDUCATION
- Education
LITERATURE
- Masterpieces of English Literature
LINGUISTICS
- American English

- English Dictionaries
- The English Language

MEDICINE
- Medical Emergencies
- The Theory of Memory
MUSIC&DANCE
- The Beatles
- Dances
- Microphones
- Musical Notation
- Music Instruments
SCIENCE
- Batteries
- Nanotechnology
LIFESTYLE
- Cosmetics
- Diets
- Vegetarianism and Veganism
TRADITIONS
- Christmas Traditions
NATURE
- Animals

- Fruits And Vegetables



ARTICLES IN THE BOOK

  1. Acute abdomen
  2. Acute coronary syndrome
  3. Acute pancreatitis
  4. Acute renal failure
  5. Agonal respiration
  6. Air embolism
  7. Ambulance
  8. Amnesic shellfish poisoning
  9. Anaphylaxis
  10. Angioedema
  11. Aortic dissection
  12. Appendicitis
  13. Artificial respiration
  14. Asphyxia
  15. Asystole
  16. Autonomic dysreflexia
  17. Bacterial meningitis
  18. Barotrauma
  19. Blast injury
  20. Bleeding
  21. Bowel obstruction
  22. Burn
  23. Carbon monoxide poisoning
  24. Cardiac arrest
  25. Cardiac arrhythmia
  26. Cardiac tamponade
  27. Cardiogenic shock
  28. Cardiopulmonary arrest
  29. Cardiopulmonary resuscitation
  30. Catamenial pneumothorax
  31. Cerebral hemorrhage
  32. Chemical burn
  33. Choking
  34. Chronic pancreatitis
  35. Cincinnati Stroke Scale
  36. Clinical depression
  37. Cord prolapse
  38. Decompression sickness
  39. Dental emergency
  40. Diabetic coma
  41. Diabetic ketoacidosis
  42. Distributive shock
  43. Drowning
  44. Drug overdose
  45. Eclampsia
  46. Ectopic pregnancy
  47. Electric shock
  48. Emergency medical services
  49. Emergency medical technician
  50. Emergency medicine
  51. Emergency room
  52. Emergency telephone number
  53. Epiglottitis
  54. Epilepsia partialis continua
  55. Frostbite
  56. Gastrointestinal perforation
  57. Gynecologic hemorrhage
  58. Heat syncope
  59. HELLP syndrome
  60. Hereditary pancreatitis
  61. Hospital
  62. Hydrocephalus
  63. Hypercapnia
  64. Hyperemesis gravidarum
  65. Hyperkalemia
  66. Hypertensive emergency
  67. Hyperthermia
  68. Hypoglycemia
  69. Hypothermia
  70. Hypovolemia
  71. Internal bleeding
  72. Ketoacidosis
  73. Lactic acidosis
  74. Lethal dose
  75. List of medical emergencies
  76. Malaria
  77. Malignant hypertension
  78. Medical emergency
  79. Meningitis
  80. Neuroglycopenia
  81. Neuroleptic malignant syndrome
  82. Nonketotic hyperosmolar coma
  83. Obstetrical hemorrhage
  84. Outdoor Emergency Care
  85. Overwhelming post-splenectomy infection
  86. Paralytic shellfish poisoning
  87. Paramedic
  88. Paraphimosis
  89. Peritonitis
  90. Physical trauma
  91. Placenta accreta
  92. Pneumothorax
  93. Positional asphyxia
  94. Pre-eclampsia
  95. Priapism
  96. Psychotic depression
  97. Respiratory arrest
  98. Respiratory failure
  99. Retinal detachment
  100. Revised Trauma Score
  101. Sepsis
  102. Septic arthritis
  103. Septic shock
  104. Sexual assault
  105. Shock
  106. Simple triage and rapid treatment
  107. Soy allergy
  108. Spinal cord compression
  109. Status epilepticus
  110. Stroke
  111. Temporal arteritis
  112. Testicular torsion
  113. Toxic epidermal necrolysis
  114. Toxidrome
  115. Triage
  116. Triage tag
  117. Upper gastrointestinal bleeding
  118. Uterine rupture
  119. Ventricular fibrillation
  120. Walking wounded
  121. Watershed stroke
  122. Wilderness first aid
  123. Wound
 



THE BOOK OF MEDICAL EMERGENCIES
This article is from:
http://en.wikipedia.org/wiki/Pneumothorax

All text is available under the terms of the GNU Free Documentation License: http://en.wikipedia.org/wiki/Wikipedia:Text_of_the_GNU_Free_Documentation_License 

Pneumothorax

From Wikipedia, the free encyclopedia

 
Left-sided pneumothorax (on the right side of the image) on CT scan of the chest with chest tube in place.
Left-sided pneumothorax (on the right side of the image) on CT scan of the chest with chest tube in place.

In medicine (pulmonology), a pneumothorax or collapsed lung is a medical emergency caused by the collapse of the lung within the pleural cavity.

It can result from:

  • A penetrating chest wound
  • Barotrauma to the lungs
  • Spontaneously (most commonly in tall slim young males and in Marfan syndrome)
  • Chronic lung pathologies including emphysema, asthma
  • Acute infections
  • Chronic infections, such as tuberculosis
  • Cancer
  • Catamenial pneumothorax (due to endometriosis in the chest cavity)

Pneumothoraces are divided into tension and non-tension pneumathoraces. A tension pneumothorax is a medical emergency as air accumulates in the pleural space with each breath. The remorseless increase in intrathoracic pressure results in massive shifts of the mediastinum away from the affected lung compressing intrathoracic vessels. A non-tension pneumothorax by contrast is a less severe pathology because the air in the pneumothorax is able to escape.

The accumulation of blood in the thoracic cavity (hemothorax) exacerbates the problem, creating a pneumohemothorax.

Signs and symptoms

Sudden shortness of breath, cyanosis (turning blue) and pain felt in the chest and/or back are the main symptoms. In penetrating chest wounds, the sound of air flowing through the puncture hole may indicate pneumothorax, hence the term "sucking" chest wound. The flopping sound of the punctured lung is also occasionally heard.

If untreated, hypoxia may lead to loss of consciousness and coma. In addition, shifting of the mediastinum away from the site of the injury can obstruct the superior and inferior vena cava resulting in reduced cardiac preload and decreased cardiac output. Untreated, a severe pneumothorax can lead to death within several minutes.

Spontaneous pneumothoraces are reported in young people with a tall stature. As men are generally taller than women, there is a preponderance among males. The reason for this association, while unknown, is hypothesized to be the presence of subtle abnormalities in connective tissue.

Pneumothorax can also occur as part of medical procedures, such as the insertion of a central venous catheter (an intravenous catheter) in the subclavian vein or jugular vein. While rare, it is considered a serious complication and needs immediate treatment. Other causes include mechanical ventilation, emphysema and rarely other lung diseases (pneumonia).

Diagnosis

The absence of audible breath sounds through a stethoscope can indicate that the lung is not unfolded in the pleural cavity. This accompanied by hyperresonance (higher pitched sounds than normal) to percussion of the chest wall is suggestive of the diagnosis. If the signs and symptoms are doubtful, an X-ray of the chest can be performed, but in severe hypoxia, emergency treatment has to be administered first.

In a supine chest X-ray the deep sulcus sign is diagnostic[1], which is characterized by a low lateral costophrenic angle on the affected side.[2] In layman's terms, the place where rib and diaphragm meet appears lower on an X-ray with a deep sulcus sign and suggests the diagnosis of pneumothorax.

Differential Diagnosis

When presented with this clinical picture, other possible causes include:

  • Acute MI: presents with shortness of breath and chest pain, though MI chest pain is characteristically crushing, central and radiating to the jaw, left arm or stomach. Whilst not a lung condition, patients having an MI often happen to also have lung disease.
  • Emphysema: here, delicate functional lung tissue is lost and replaced with air spaces, giving shortness of breath, and decreased air entry and increased resonance on examination. However, it is usually a chronic condition, and signs are diffuse (not localised as in pneumothorax).

Careful history taking and examination and a chest x-ray will allow accurate diagnosis.

Pathophysiology

The lungs are located inside the chest cavity, which is a hollow space. Air is drawn into the lungs by the diaphragm (a powerful abdominal muscle). The pleural cavity is the region between the chest wall and the lungs. If air enters the pleural cavity, either from the outside (open pneumothorax) or from the lung (closed pneumothorax), the lung collapses and it becomes mechanically impossible for the injured person to breathe, even with an open airway. If a piece of tissue forms a one-way valve that allows air to enter the pleural cavity from the lung but not to escape, overpressure can build up with every breath; this is known as tension pneumothorax. It may lead to severe shortness of breath as well as circulatory collapse, both life-threatening conditions. This condition requires urgent intervention.

First Aid

Chest wound

Penetrating wounds require immediate coverage with an occlusive dressing, field dressing, or pressure bandage made air-tight with petroleum jelly or clean plastic sheeting. The sterile inside of plastic bandage packaging is good for this purpose; however any airtight material, even the cellophane of a cigarette pack, can be used. A small opening, known as a flutter valve, needs to be left open, so the air can escape while the lung reinflates. Any patient with a penetrating chest wound must be closely watched at all times and may develop a tension pneumothorax or other immediately life-threatening respiratory emergency at any moment. They cannot be left alone.

Blast injury or spontaneous

If the air in the pleural cavity is due to a tear in the lung tissue (in the case of a blast injury or tension pneumothorax), it needs to be released. A thin needle can be used for this purpose, to relieve the pressure and allow the lung to reinflate.

Pre-hospital care

Many paramedics can perform needle thoracocentesis to relieve intrathoracic pressure. Intubation may be required, even of a conscious patient, if the situation deteriorates. Advanced medical care and immediate evacuation are strongly indicated.

An untreated pneumothorax is an absolute contraindication of evacuation or transportation by flight.

Clinical treatment

Small Pneumothoraces require no treatment other than repeat observation via Chest X-rays.

Larger Pneumothoraces may require tube thoracostomy, also known as chest tube placement. A tube is inserted into the chest wall outside the lung and air is extracted using a simple one way valve or vacuum and a water valve device, depending on severity. This allows the lung to re-expand within the chest cavity. The pneumothorax is followed up with repeated X-rays. If the air pocket has become small enough, the vacuum drain can be clamped temporarily or removed.

In case of penetrating wounds, these require attention, but generally only after the airway has been secured and a chest drain inserted. Supportive therapy may include mechanical ventilation.

Recurrent pneumothorax may require further corrective and/or preventative measures such as pleurodesis. If the pneumothorax is the result of bullae, then bullaectomy (the removal or stapling of bullae or other faults in the lung) is preferred. Pleurodesis is the injection of a chemical irritant that triggers an inflammatory reaction, leading to adhesion of the lung to the parietal pleura. Substances used for pleurodesis include talc, blood and bleomycin.

History

Jean Marc Gaspard Itard, a student of Rene Laennec, first recognised pneumothorax in 1803, and Laennec himself described the full clinical picture in 1819[3].

Prior to the advent of anti tuberculous medications, iatrogenic pneumothoraces were intentionally given to tuberculosis patients in an effort to collapse a lobe, or entire lung around a cavitating lesion. This was known as 'resting the lung' .

References

  1. ^ Kong A. The deep sulcus sign. Radiology. 2003 Aug;228(2):415-6. PMID 12893899 Full Text
  2. ^ Gordon R. The deep sulcus sign. Radiology. 1980 Jul;136(1):25-7. PMID 7384513
  3. ^ Laennec RTH. Traite de l'auscultation mediate et des maladies des poumons et du coeur. Part II. Paris, 1819.

See also

  • Emergency medicine
  • Tension pneumothorax
  • Pleural effusion
  • Sucking chest wound:
    • Occlusive dressing
    • Field dressing
    • Pneumohemothorax

External links

  • A chest X-ray with a deep sulcus sign - learningradiology.com
  • Pneumothorax.org - Pneumothorax news, information and forums
  • Music as a cause of primary spontaneous pneumothorax. An article from the journal Thorax detailing links between exposure to loud music and pneumothorax.
  • Sucking chest wound:
    • Brookside Press / US Army - Treat a Sucking Chest Wound
Retrieved from "http://en.wikipedia.org/wiki/Pneumothorax"
 

 

 

 

 

 
CONDIZIONI DI USO DI QUESTO SITO
L'utente può utilizzare il nostro sito solo se comprende e accetta quanto segue:

  • Le risorse linguistiche gratuite presentate in questo sito si possono utilizzare esclusivamente per uso personale e non commerciale con tassativa esclusione di ogni condivisione comunque effettuata. Tutti i diritti sono riservati. La riproduzione anche parziale è vietata senza autorizzazione scritta.
  • Il nome del sito EnglishGratis è esclusivamente un marchio e un nome di dominio internet che fa riferimento alla disponibilità sul sito di un numero molto elevato di risorse gratuite e non implica dunque alcuna promessa di gratuità relativamente a prodotti e servizi nostri o di terze parti pubblicizzati a mezzo banner e link, o contrassegnati chiaramente come prodotti a pagamento (anche ma non solo con la menzione "Annuncio pubblicitario"), o comunque menzionati nelle pagine del sito ma non disponibili sulle pagine pubbliche, non protette da password, del sito stesso.
  • La pubblicità di terze parti è in questo momento affidata al servizio Google AdSense che sceglie secondo automatismi di carattere algoritmico gli annunci di terze parti che compariranno sul nostro sito e sui quali non abbiamo alcun modo di influire. Non siamo quindi responsabili del contenuto di questi annunci e delle eventuali affermazioni o promesse che in essi vengono fatte!
  • Coloro che si iscrivono alla nostra newsletter (iscrizione caratterizzatalla da procedura double opt-in) accettano di ricevere saltuariamente delle comunicazioni di carattere informativo sulle novità del sito e, occasionalmente, delle offerte speciali relative a prodotti linguistici a pagamento sia nostri che di altre aziende. In ogni caso chiunque può disiscriversi semplicemente cliccando sulla scritta Cancella l'iscrizione che si trova in fondo alla newsletter, non è quindi necessario scriverci per chiedere esplicitamente la cancellazione dell'iscrizione.
  • L'utente, inoltre, accetta di tenere Casiraghi Jones Publishing SRL indenne da qualsiasi tipo di responsabilità per l'uso - ed eventuali conseguenze di esso - degli esercizi e delle informazioni linguistiche e grammaticali contenute sul siti. Le risposte grammaticali sono infatti improntate ad un criterio di praticità e pragmaticità più che ad una completezza ed esaustività che finirebbe per frastornare, per l'eccesso di informazione fornita, il nostro utente.

     

    ENGLISHGRATIS.COM è un sito di Casiraghi Jones Publishing SRL
    Piazzale Cadorna 10 - 20123 Milano - Italia
    Tel. 02-36.55.30.40 - email:
    Iscritta al Registro Imprese di MILANO - C.F. e PARTITA IVA: 11603360154
    Iscritta al R.E.A. di Milano n.1478561 • Capitale Sociale
    10.400 interamente versato

    Roberto Casiraghi                                                                                Crystal Jones