Pneumothorax; The word means that there is air in the chest cavity where it should not be. This air accumulates outside the lungs inside the rib cage. The result of this is the collapse of the lungs, that is collapse, and the patient presents as respiratory distress. It is causally divided into spontaneous and secondary pneumothorax (px). Spontaneous px is the escaping of the air in the lungs into the pleural space as a result of the bursting of bubbles called bullae that can be found in the lungs. It is common in lean tall young men.
If the secondary px is the main title; It occurs as a result of underlying parenchymal disease or trauma. Parenchymal disease varies with age. Lung immaturity (hyaline membrane disease, surfactant deficiency) in the neonatal age group may cause a tear in the parenchyma as a result of positive pressure ventilation. In older children, infectious conditions such as pneumonia and empyema are seen as causative agents. As age increases, trauma becomes more prominent.
As a result of trauma, px is most commonly caused by rib fractures penetrating the pleura. The air in the lung, that is, the bronchial system, escapes into the pleural space. In open injuries of the thorax, air enters the chest cavity from the outside, in which case the incoming air cannot escape in expiration and more and more air begins to accumulate. This condition, called blood pressure px, is increasingly life-threatening. As a result of the contusion, that is, crushing of the thorax, a more severe picture is observed, where blood and interstitial fluid escape into the alveolar area in both the px and lung parenchyma. This leads to deterioration of oxygen exchange as a result of both parenchymal damage and collapse of the lung that cannot be expanded due to px. Laceration in the main airways, the trachea and main bronchi, is also a serious condition. Trachea and main bronchi may be injured as a result of contusion of the thorax when the epiglottis is closed or in direct trauma to the neck region. Here, subcutaneous emphysema is typically present. Emphysema increases with each inspiration.
The main feeling of the patient is inability to breathe adequately, that is, dyspnea. Chest pain, rapid breathing, and tachycardia are other findings. Unexpected decrease in blood oxygen saturation is seen in intubated patients. Breath sounds are absent or decreased on the px side. Typical appearance on chest X-ray; collapse of the lung and the presence of air in the chest cavity. Even if it is not symptomatic, the diagnosis is made with the same appearance in radiography controls, as it is an expected situation in secondary px. In doubtful cases or for differential diagnosis, lung tomography can be taken.
The gold standard treatment is tube thoracostomy and underwater drainage. The patient is in the supine position, with the arm overhead, and the midaxillary line is entered through the 3rd to 5th intercostal space. The sound of air coming out is heard when the pleura is passed. It is taken to tube fixations and underwater drainage, it can be seen that px is thrown out of the bottle. Control chest X-ray is taken, the location of the tube is seen. The residence time of the tube varies according to the clinical condition of the patient. With the negative pressure applied to the bottle while the tube is withdrawn, the pleura is adhered to the chest wall from the inside. There is an indication for thoracoscopy in recurrent px.
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