Collapsed Lung | Atelectasis | Pneumothorax

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A collapsed lung happens when air enters the pleural space, the area between the lung and the chest wall. If it is a total collapse, it is called pneumothorax. If only part of the lung is affected, it is called atelectasis.

Causes of a collapsed lung include:

• Lung diseases such as pneumonia or lung cancer
• Being on a breathing machine
• Surgery on the chest or abdomen
• A blocked airway

If only a small area of the lung is affected, you may not have symptoms. If a large area is affected, you may feel short of breath and have a rapid heart rate.

A chest x-ray can tell if you have it. Treatment depends on the underlying cause.

NIH: National Heart, Lung, and Blood Institute

• Atelectasis

  (Mayo Foundation for Medical Education and Research)

• Pneumothorax

  (Mayo Foundation for Medical Education and Research)

  Also in Spanish

• Bronchoscopy and Bronchoalveolar Lavage (BAL)

  (National Library of Medicine)

  Also in Spanish

• Shortness of Breath

  (American Academy of Family Physicians)

  Also in Spanish

• Tests for Lung Disease

  (National Heart, Lung, and Blood Institute)

  Also in Spanish

• What Is LAM (Lymphangioleiomyomatosis)?

  (National Heart, Lung, and Blood Institute)

  Also in Spanish

• ClinicalTrials. gov: Pneumothorax

  (National Institutes of Health)

• ClinicalTrials.gov: Pulmonary Atelectasis

  (National Institutes of Health)

• Article: Clinical Effect of Modified Ultrasound-Guided Subclavian Vein Puncture.

• Article: SIMUNEO: Control and Monitoring System for Lung Ultrasound Examination and Treatment…

• Article: Sub-axillary cosmetic incision versus single-incision thoracoscopic surgery for primary spontaneous pneumothorax.

• Collapsed Lung — see more articles

• How the Lungs Work

  (National Heart, Lung, and Blood Institute)

  Also in Spanish

• American Lung Association

• Lung HelpLine and Tobacco QuitLine

  (American Lung Association)

• National Heart, Lung, and Blood Institute

What Is a Collapsed Lung?

by Editorial Staff |
April 24, 2019

Topics:

• Health & Wellness

Our lungs are responsible for bringing oxygen into the bloodstream and removing carbon dioxide from our bodies. Each lung expands like a balloon when we inhale air, but what happens if the balloon cannot inflate?

That’s what is called a collapsed lung, a term that you might have heard before—it happens sometimes when there is trauma, such as a rib puncturing the lung—like what happened to UFC fighter Paul Felder in a recent match. But there are many reasons it can occur—ruptured air sacs, issues from underlying lung diseases like COPD and cystic fibrosis, even screaming too hard at a One Direction concert. What exactly makes a lung collapse? Introducing pneumothorax.

First some lung basics: Your lungs are located inside the chest wall. Each lung is divided into lobes which are similar to balloons filled with sponge-like tissue. The lobes are surrounded by the visceral pleura, membranes that separate your lungs from your chest wall. As you breathe in and out, the lungs slide against the parietal pleura – a plastic wrap-like membrane that covers the chest wall. However, if one of your “balloons” leaks, for example when COPD causes holes in the lung tissue, the air you inhale is going to travel through the leak and into space between your lungs and chest, called the pleural cavity. Similarly, if there is a hole in the parietal pleura (like a bullet through the chest wall, for example), that can cause air to enter the pleural cavity directly from the outside.

“Because that air has nowhere to go, it keeps accumulating inside this space and builds up pressure between the chest wall and the lungs.  As the pressure and amount of air in this cavity increase it compresses your lung further and further, making it unable to expand when you breathe. That is a pneumothorax.” says Dr. Rutland, pulmonary and critical care physician and American Lung Association volunteer spokesperson. Pneumothorax is the medical term most people associate with a lung collapse but actually means “air in the pleura space causing your lungs to collapse or be compressed.” The pressure from the air keeps your lungs from being able to fully expand.

The term “collapsed lung” is often used in everyday speech as being the same as a pneumothorax.  However, a lung can collapse in two general ways—pressure from “outside” the lung as in pneumothorax described above or from lack of flow “into” the lung because the bronchial tubes or “pipes” are blocked by mucus, a polyp or a tumor. This type of collapsed lung is medically termed an atelectatic lung or atelectasis and is treated differently.

What are the symptoms of a pneumothorax

Symptoms of pneumothorax include shortness of breath, chest pain on one side, and experiencing pain when breathing. If you suspect you have pneumothorax, go to the emergency room right away. A chest X-ray will confirm this.

How is a pneumothorax treated?

Depending on the cause and the size of the leak, the lung can often heal itself, but in order to do so, the extra air in the pleura space needs to be removed to reduce the pressure so the lung can re-expand. If the size of the pneumothorax is large and creating significant distress, an emergency procedure includes the doctor placing a needle in the chest to remove the pressure quickly. This is then followed by placing a tube in the chest that is kept in place for a day or two until the leak is healed and closed and the lung is re-expanded. ” 

This hollow tube is inserted between the ribs and is attached to a suction device to remove the air in the pleura space.⁵ Once this chest tube is inserted, it typically takes about 48 hours or so for the lung to heal.

Dr. Rutland says a simple test is performed to tell if the lung has healed. First, the chest tube is hooked up to a chamber system with water. Then the patient is instructed to cough. If air is escaping from the lung into the tube, bubbles will appear in the water chamber. “Once there are no more bubbles rushing through when I tell my patients to cough, then I know that the lung is healed, and I can take the tube out.”

How can I prevent pneumothorax?

While most cases cannot be prevented, discontinuing the use of tobacco products can reduce your risk of lung disease associated with pneumothorax. While males are generally more likely to experience pneumothorax, your genetics can also predispose you to certain types.

• Sources
  1. https://www. lung.org/about-us/blog/2017/07/how-your-lungs-work.html
  2. https://www.lung.org/lung-health-and-diseases/how-lungs-work/
  3. Dr. Rutland interview
  4. https://www.mayoclinic.org/diseases-conditions/atelectasis/symptoms-causes/syc-20369684
  5. https://www.health.harvard.edu/a_to_z/pneumothorax-a-to-z
  6. https://www.mayoclinic.org/diseases-conditions/pneumothorax/symptoms-causes/syc-20350367

Blog last updated: November 17, 2022

Silencer popping – what does it mean? Why is he shooting at the silencer?

08/15/2019

Contents of the article:

• Fuel system overflow
• Silencer pops when stepping on the gas
• When the injector and diesel fire
• Claps on gas-powered vehicles

Muffler ‘shooting’ problem is common in cars with carbureted engines and is related to powertrain problems. The solution can be different – from a small repair to replacing the muffler.

Main causes of the problem

Silencer popping can occur due to the following reasons:

• An explosion of a combustible mixture that did not have time to burn out during the implementation of the work cycle. Such pops can occur in systems with both a carburetor and an injector.
• Valve timing mismatch.
• Machine air filter dirty.
• Failure of the size of the thermal gap on the cylinder head valve (if the problem occurs at high or low speeds).
• Late ignition is also a common reason why the muffler fires. In this case, the ejection of a certain amount of fuel into the manifold is inevitable.
• Too weak spark. This may be due to problems with candles, toggle switches, contact groups, wired contacts.
• Timing belt stretching. In this case, shots are heard only when the system is warm, and not immediately when you press the gas.
• Pops in the injector may be due to insufficient reliability of the sensor contacts.

If the muffler pops, do not use the vehicle. The maximum is to get to the car service. Prolonged ignoring of lumbago will lead to serious engine damage.

There is another possible reason why the muffler fires is the use of low-quality low-octane fuel. In this case, it is enough to switch to more expensive gasoline.

Fuel System Overflow

When the carburetor delivers too much gasoline, some of the fuel/air mixture enters the exhaust manifold and the engine shoots up the exhaust pipe. Typically, such a problem is diagnosed by a pronounced smell of gasoline in the cabin and under the hood, as well as by black smoked candle electrodes. At the same time, black smoke comes out of the exhaust pipe, often with soot impurities.

The first thing to do is check the air filter. When it is heavily clogged, the engine draws in more fuel than it needs. It may also be that the tightness of the needle valve inside the float chamber is lost or the pump diaphragm is ruptured.

With excessive supply of gasoline, the idle speed floats or increases to 2-2.5 thousand per minute. When you release the gas while driving, there is also a problem of shots if the speed is on.

Silencer pops when stepping on the gas

If the car does not start, and shots are clearly audible in the muffler, this is practically a guarantee that the device is in a state close to an explosion. You should immediately stop trying to start the car and take the following measures:

• Inspect the spark plugs. If the electrodes are dirty, replace them.
• Tighten or replace the timing belt if necessary.
• Check the operation of the crankshaft position sensor.
• Change the pressure inside the fuel line. Replace the pump if the reading is below 3.
• Check engine compression level. The occurrence of rings can be one of the causes of lumbago. To solve the problem, you can try draining the oil and pouring kerosene into the cylinders. Then unscrew the candles, turn the starter. Let the car stand for a while, then drain the kerosene and pour in new oil. Try to start the engine.
• Try to start with the RTO sensor disabled. This will bring clarity to the definition of the cause.

When the injector and diesel fire

In the old diesel power devices it was possible to manually adjust the moment of diesel injection mechanically. If the setting was carried out incorrectly, then the fuel was compressed too much, white smoke came out of the engine. Today, this situation is rare, since everything is controlled by electronics, including VAZ and Gazelle.

But there are other reasons for shooting in modern type systems:

• The lambda probe, DBP, DMRV sensors are broken, or the throttle position is incorrectly set.
• Faulty high voltage ignition unit.
• Supervisory controller errors.
• The working surface of the crankshaft position sensor is excessively contaminated with metal chips.

If it is assumed that the problem is in controller errors, then you can try to reset the settings by disconnecting the battery for fifteen minutes. Even if the method helped, it is still recommended to check the car in the service in order to avoid repetition of the situation.

If the power unit often shoots when the gas is released, then there is a possibility of problems with the gas equipment of the car. The system supplies liquefied propane to the cylinders under the control of a separate electronic unit; the process involves a reducer and valves along with a cylinder. If there is any breakdown in the system, the gas will overflow, resulting in pops. There is no need to explain why go to the service in this case – self-repair is impossible.

Gas car pops

The problem is also found in cars with LPG, using liquefied gas as a fuel. Moreover, according to statistics, this situation is widespread.

Pops appear both in mufflers (and in general in the exhaust system) and in the intake manifold. The two main causes of the problem are:

• Insufficient or unstable gas supply. This happens if the gearbox is incorrectly configured or the filter is clogged. Sometimes the culprit is the DMRV (mass air flow sensor), which is present in injection cars.
• Incorrectly set ignition angle. With early ignition, a filter or manifold will shoot, with a late muffler.

Video about the consequences of cotton in the muffler:

Whatever car you use – carburetor, injection, LPG – always follow the basic settings of all systems. Do not neglect regular vehicle inspection and always pay attention to the first signs of problems. Our company will help both with preventive measures and with the repair or replacement of the muffler.

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Laryngopharyngeal reflux – causes, symptoms and treatment

Laryngopharyngeal reflux is not an independent disease, but one of the most common manifestations of gastroesophageal disease (GERD), a pathology of the digestive system, in which the contents of the stomach or duodenum are regularly thrown into the esophagus and cause inflammation of its walls.

Laryngopharyngeal reflux is estimated to occur in about 10% of people diagnosed with gastroesophageal reflux (GERD). Most often, reflux affects people of young and middle age: 20-60 years.

Mechanism of laryngopharyngeal reflux

The esophagus is a hollow muscular tube that connects the pharynx to the stomach. Wave-like contraction of the esophagus allows you to push the chewed food into the stomach.

In the upper and lower parts of the esophagus there are special valves – sphincters

Sphincters are located in the upper and lower parts of the esophagus – special valves that allow liquid and food to pass only down into the stomach. Outside of eating, these valves are normally closed and prevent gastric contents (undigested food and gastric juice) from entering the esophagus.

Gastric juice contains hydrochloric acid, which helps digest food. Acid does not harm the stomach, but it acts destructively on other organs.

In laryngopharyngeal reflux, the upper esophageal sphincter does not close completely. As a result, the contents of the stomach are thrown into the esophagus, and from there into the upper respiratory tract and larynx and damage their mucous membranes.

Causes of laryngopharyngeal reflux

There are a number of factors that can trigger the development of laryngopharyngeal reflux.

Main causes of LPR:

• eating large amounts of salty, fatty foods, chocolate, coffee, carbonated drinks, alcohol;
• peptic ulcer of the stomach and duodenum;
• chronic gastroduodenitis – simultaneous damage to the mucous membrane of the stomach and duodenum;
• hiatal hernia – a hernial protrusion that appears when the lower esophagus, upper stomach and intestinal loops are displaced into the chest cavity;
• cholelithiasis – the formation of stones in the gallbladder;
• increased intra-abdominal pressure with flatulence, large neoplasms of internal organs or retroperitoneal space, severe obesity, as well as during pregnancy;
• taking certain drugs from the nitrate group, calcium channel blockers, antidepressants;
• irregular meals, habit of overeating before going to bed;
• Working in a bent or stooped position or taking such postures immediately after eating.

One of the causes of laryngopharyngeal reflux is eating a lot of fatty and fried foods

Symptoms of laryngopharyngeal reflux

The main symptoms of laryngopharyngeal reflux are an unproductive cough and sore throat that worsens after eating. Without timely treatment, there is a risk of developing dysphonia: the voice becomes hoarse or may completely disappear. In this case, it is only possible to speak in a whisper. Unpleasant sensations may appear in the ear area – congestion, pops.

Complications of laryngopharyngeal reflux

In LPR, the mucous membranes of the mouth and upper respiratory tract are constantly injured by the acidic contents of the stomach. Over time, this can provoke sluggish inflammatory processes.

The most common complications of laryngopharyngeal reflux – LPR:

• chronic tonsillitis – inflammation of the palatine tonsils;
• laryngitis – inflammation of the mucous membrane of the larynx;
• adenoiditis – acute or chronic inflammation of the pharyngeal tonsil;
• chronic tracheobronchitis – inflammation of the mucous membrane of the bronchi, trachea and bronchioles (terminal branches of the bronchial tree).

Diagnosis of laryngopharyngeal reflux

Diagnosis of “laryngopharyngeal reflux” is made on the basis of patient complaints, examination data and instrumental and laboratory studies.

Inspection

At the appointment, the doctor conducts a survey: he studies the patient’s diet, eating habits, be sure to pay attention to comorbidities and factors that may contribute to an increase in intra-abdominal pressure.

The Reflux Symptom Index (RSI) scale is sometimes used for preliminary diagnosis of LPR. The assessment is carried out on a five-point scale, where 0 – the symptom is absent, 5 – the symptom is pronounced.

If the RSI is 10 or more, the patient may be suspected of having laryngopharyngeal reflux.

Next, the specialist examines the patient’s pharynx and larynx using special lighting and mirrors. On the back and side walls of the pharynx with LPR, enlarged lymphoid follicles are usually found – they look like grains on the mucous membrane. Mucus is visible between the palatine arches, there may be plugs in the tonsils. At the same time, the mucous membrane of the pharynx is swollen and cyanotic.

When examining the larynx, the doctor may find ulceration in the vocal folds and laryngeal cartilages.

If, based on the results of the interview and examination, the doctor suspects LPR – laryngopharyngeal reflux, he may prescribe instrumental examinations to the patient to confirm the diagnosis.

Instrumental diagnostics

One of the main ways to confirm or exclude laryngopharyngeal reflux is laryngoscopy (examination of the larynx using a special mirror). The procedure allows you to assess in detail the condition of the mucous membrane of the mouth and larynx, to identify violations in the work of the vocal cords.

Also, for diagnostics, FGDS can be prescribed – fibrogastroduodenoscopy . During the procedure, a thin tube is inserted through the patient’s mouth into the esophagus, at the end of which there is a camera and a special flashlight. The procedure is not too pleasant, but does not last long.

According to the results of EGD, the doctor can assess the condition of the mucous membrane of the esophagus and sphincters – valves that are located in its upper and lower parts

Intragastric pH is a method that measures the acidity of the gastric juice and evaluates how damaging the stomach contents are to the esophagus. During the study, a flexible probe is inserted into the corresponding section of the gastrointestinal tract. The results obtained from the probe are processed by a computer.

Esophageal impedancemetry is a study that allows you to detect the movement of gastric contents into the esophagus and evaluate how often and for how long this happens, how the process is affected by the position of the person’s body, the amount of food and the type of medications that he takes. During the procedure, a thin probe equipped with special sensors is inserted into the esophagus and left for 24 hours.

To determine the causes of LPR, the doctor may refer the patient to laboratory tests.

Laboratory diagnostics

So, if chronic gastroduodenitis is suspected, it is useful to take an analysis for Helicobacter in feces by PCR. The bacterium Helicobacter pylori is one of the main causative agents of inflammatory diseases of the stomach and duodenum, including gastroduodenitis.

Helicobacter, DNA (Helicobacter pylori, PCR) feces, quality.

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LPR can also provoke cholelithiasis. A general and biochemical blood test helps to suspect it. The CBC will show non-specific signs of inflammation – an increase in ESR and the concentration of leukocytes. The results of a biochemical study can confirm hypercholesterolemia (increased blood levels of cholesterol), hyperbilirubinemia (high levels of bilirubin) and an increase in alkaline phosphatase activity.

Complete blood count extended with leukocyte formula and reticulocytes (only venous blood)

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Treatment of laryngopharyngeal reflux

LPR treatment is carried out simultaneously with GERD therapy and includes two main areas: lifestyle changes and the use of proton pump inhibitors (PPIs).

Basic recommendations related to the patient’s lifestyle:

• stop smoking and drinking alcohol;
• monitor body weight;
• to sleep with the head of the bed raised by 15 cm;
• do not wear tight belts, corsets, bandages;
• adjust the diet: do not overeat at night, avoid fatty and fried foods, citrus fruits, coffee, chocolate;
• do not lie down immediately after eating;
• do not take uncontrolled drugs that provoke reflux (reflux of stomach contents into the esophagus): nitrates and calcium channel blockers (they are prescribed for heart disease), as well as antidepressants.

Proton pump inhibitors are medicines that permanently reduce stomach acid production. Usually they are prescribed in standard doses, then the dosage is reduced and gradually switched to maintenance therapy for a period of 6 months to 1 year. The dosage regimen is prescribed by the attending physician.

In difficult cases, surgical treatment may be required – Nissen fundoplication: the fundus of the stomach is wrapped around the esophagus, thus creating a cuff that prevents gastric juice from flowing back into the esophagus.

Which doctor to contact for laryngopharyngeal reflux

Laryngopharyngeal reflux is treated by an otolaryngologist (ENT) – a specialist in diseases of the larynx, pharynx, nose, and ears. He often works with a gastroenterologist.

Prognosis and prevention

With timely treatment and compliance with all doctor’s recommendations, the prognosis is favorable.

Neglected cases and self-treatment can lead to complications: chronic tonsillitis, pharyngitis and other diseases, including pneumonia – pneumonia.