How does a collapsed lung feel. What are the common causes of pneumothorax. How is a collapsed lung diagnosed and treated. Can pneumothorax be prevented. What are the long-term effects of a collapsed lung.

What is Pneumothorax: Defining a Collapsed Lung

Pneumothorax, commonly known as a collapsed lung, is a condition where air escapes from the lung and fills the space between the lung and chest wall. This occurrence prevents the lung from expanding normally during inhalation, potentially leading to severe respiratory complications. While rare, pneumothorax can be life-threatening and requires immediate medical attention.

The Mechanics of Lung Collapse

To understand pneumothorax, it’s crucial to grasp the basic mechanics of lung function. The lungs are enclosed within the chest cavity, surrounded by a thin, double-layered membrane called the pleura. Normally, there’s a small amount of fluid between these layers, allowing the lungs to slide smoothly during breathing. When air enters this space, it disrupts the negative pressure that keeps the lungs expanded, causing them to collapse partially or fully.

Recognizing the Symptoms of a Collapsed Lung

Identifying the signs of pneumothorax early can be crucial for prompt treatment. The symptoms can vary in severity depending on the extent of the lung collapse.

• Sudden, sharp chest pain that worsens with deep breathing or coughing
• Shortness of breath or difficulty breathing
• Rapid heart rate
• Bluish skin color due to lack of oxygen (cyanosis)
• Fatigue and weakness
• Dry, hacking cough

In some cases, particularly with small pneumothoraces, symptoms may be mild or even absent. However, any suspicion of a collapsed lung warrants immediate medical evaluation.

When to Seek Medical Attention

Is it possible to mistake pneumothorax for other conditions? While some symptoms of a collapsed lung may resemble those of other respiratory or cardiac issues, it’s essential not to self-diagnose. Seek emergency medical care if you experience sudden chest pain accompanied by difficulty breathing, especially if you have risk factors or a history of lung disease.

Common Causes and Risk Factors of Pneumothorax

Understanding the causes of pneumothorax can help identify individuals at higher risk and potentially prevent occurrences. There are several types of pneumothorax, each with distinct causes:

Primary Spontaneous Pneumothorax

This type occurs without apparent cause in people with no known lung disease. It’s more common in:

• Tall, thin individuals, particularly males
• Smokers
• People between the ages of 20 and 40

Secondary Spontaneous Pneumothorax

This type is associated with underlying lung conditions such as:

• Chronic obstructive pulmonary disease (COPD)
• Cystic fibrosis
• Lung cancer
• Pneumonia
• Tuberculosis

Traumatic Pneumothorax

Caused by chest injuries, including:

• Blunt trauma from car accidents or sports injuries
• Penetrating injuries from stab wounds or fractured ribs
• Barotrauma from scuba diving or flying at high altitudes

Iatrogenic Pneumothorax

This type results from medical procedures such as:

• Lung biopsies
• Central line placement
• Mechanical ventilation

Diagnosing Pneumothorax: From Symptoms to Confirmation

Accurate diagnosis of pneumothorax is crucial for appropriate treatment. Healthcare providers use a combination of physical examination and imaging studies to confirm the condition.

Physical Examination

During a physical exam, a doctor may:

• Listen to breath sounds with a stethoscope
• Observe chest movement during breathing
• Assess skin color for signs of cyanosis
• Check vital signs, including heart rate and blood pressure

Imaging Studies

Diagnostic imaging is essential for confirming pneumothorax and determining its extent. Common imaging techniques include:

• Chest X-ray: The primary tool for diagnosing pneumothorax
• CT scan: Provides more detailed images, useful for detecting small pneumothoraces
• Ultrasound: Increasingly used for rapid bedside diagnosis, especially in emergency settings

How accurate are these diagnostic methods? While chest X-rays are highly effective in detecting most cases of pneumothorax, CT scans offer superior sensitivity, particularly for small or loculated air collections. Ultrasound has shown promising results in emergency situations, with the added benefit of avoiding radiation exposure.

Treatment Approaches for Collapsed Lungs

The treatment of pneumothorax depends on its size, cause, and the patient’s overall health. Options range from conservative management to invasive procedures.

Observation and Oxygen Therapy

For small, uncomplicated pneumothoraces, doctors may recommend:

• Close observation in a hospital setting
• Supplemental oxygen to help reabsorb the trapped air
• Pain management

Needle Aspiration

This procedure involves inserting a needle into the chest cavity to remove excess air. It’s often used for smaller pneumothoraces or as an initial treatment before considering more invasive options.

Chest Tube Insertion

For larger pneumothoraces or those that don’t resolve with needle aspiration, a chest tube may be inserted to continuously drain air and allow the lung to re-expand. This procedure, known as thoracostomy, typically requires a hospital stay.

Pleurodesis

To prevent recurrence, especially in cases of secondary spontaneous pneumothorax, doctors may perform pleurodesis. This procedure involves irritating the pleural surfaces to create adhesions, reducing the risk of future air leaks.

Surgery

In cases of recurrent pneumothorax or when other treatments fail, surgical intervention may be necessary. Options include:

• Video-assisted thoracoscopic surgery (VATS)
• Thoracotomy for more complex cases

What factors influence the choice of treatment? The decision depends on the size of the pneumothorax, its cause, the patient’s overall health, and the risk of recurrence. Minimally invasive approaches are generally preferred when feasible, but more aggressive treatments may be necessary for severe or recurrent cases.

Recovery and Long-Term Outlook After Pneumothorax

Recovery from pneumothorax varies depending on the severity of the condition and the treatment received. Understanding the recovery process and potential long-term effects is crucial for patients and caregivers.

Immediate Post-Treatment Period

After treatment, patients typically experience:

• Gradual improvement in breathing
• Decreased chest pain
• Regular monitoring through chest X-rays

The duration of hospital stay varies, ranging from a few days for simple cases to weeks for more complex situations.

Long-Term Recovery

Once discharged, patients are advised to:

• Avoid strenuous activities for several weeks
• Refrain from air travel and scuba diving for a specified period
• Attend follow-up appointments for ongoing evaluation

Complete lung re-expansion typically occurs within a few weeks to months, depending on the extent of the collapse and the individual’s overall health.

Potential Complications and Recurrence

While most people recover fully from pneumothorax, some may experience complications or recurrence. Potential issues include:

• Chronic pain at the site of chest tube insertion
• Reduced lung function, particularly in cases of extensive or recurrent pneumothorax
• Increased risk of future pneumothoraces, especially in those with underlying lung conditions

How can the risk of recurrence be minimized? Lifestyle modifications, such as smoking cessation and avoiding high-risk activities, play a crucial role. For those with a history of recurrent pneumothorax, preventive procedures like pleurodesis may be recommended.

Preventing Pneumothorax: Risk Reduction Strategies

While not all cases of pneumothorax can be prevented, certain measures can help reduce the risk, particularly for those with known risk factors.

Lifestyle Modifications

Key preventive strategies include:

• Quitting smoking and avoiding secondhand smoke
• Maintaining a healthy weight
• Protecting yourself from respiratory infections
• Avoiding sudden changes in air pressure (e.g., scuba diving) if you have a history of lung problems

Managing Underlying Conditions

For those with chronic lung diseases, proper management is crucial:

• Adhering to prescribed treatments for conditions like COPD or cystic fibrosis
• Regular check-ups with a pulmonologist
• Prompt treatment of respiratory infections

Occupational Safety

Individuals in high-risk occupations should take appropriate precautions:

• Using proper protective equipment in jobs involving lung irritants
• Following safety protocols in professions with a risk of chest trauma
• Regular health screenings for those in high-risk occupations

Can pneumothorax be completely prevented? While it’s not always possible to prevent pneumothorax, especially in cases of spontaneous occurrence, these strategies can significantly reduce the risk, particularly for those with known predisposing factors.

Living with the Risk: Coping Strategies for Those Prone to Pneumothorax

For individuals who have experienced pneumothorax or are at high risk due to underlying conditions, learning to live with this potential threat is crucial. Developing coping strategies and maintaining a proactive approach to lung health can significantly improve quality of life.

Education and Awareness

Understanding your condition is the first step in effective management:

• Stay informed about the latest research and treatment options
• Join support groups or online communities for shared experiences and advice
• Educate family members and close friends about pneumothorax and its symptoms

Emotional Well-being

The psychological impact of living with the risk of pneumothorax shouldn’t be underestimated:

• Consider counseling or therapy to address anxiety or fear related to potential recurrence
• Practice stress-reduction techniques like meditation or yoga
• Maintain open communication with healthcare providers about any concerns

Lifestyle Adaptations

Making informed choices about daily activities can help manage risk:

• Develop an emergency plan with your doctor for quick action if symptoms occur
• Choose low-impact exercises that don’t strain the chest area
• Be cautious with activities that involve rapid changes in air pressure

How can one balance caution with living a full life? The key lies in informed decision-making. While it’s important to be aware of the risks, it’s equally crucial not to let fear dictate your life. Work closely with your healthcare team to understand which activities are safe and which should be approached with caution or avoided.

Advancing Research: Future Directions in Pneumothorax Treatment and Prevention

The field of pneumothorax research is continually evolving, with new studies and technologies offering hope for improved treatment and prevention strategies. Understanding these advancements can provide insight into future care possibilities for those affected by or at risk of pneumothorax.

Innovative Treatment Approaches

Emerging treatment options include:

• Endobronchial valves: One-way valves placed in the airways to help seal air leaks
• Autologous blood patch pleurodesis: Using the patient’s own blood to seal air leaks
• Minimally invasive surgical techniques: Advancing VATS procedures for better outcomes and faster recovery

Genetic Research

Ongoing studies are exploring the genetic factors that may predispose individuals to pneumothorax:

• Identifying genetic markers associated with increased risk
• Developing targeted preventive strategies based on genetic profiles
• Understanding familial patterns of pneumothorax occurrence

Predictive Modeling and AI

Advancements in technology are paving the way for more personalized care:

• AI-assisted imaging analysis for early detection of potential air leaks
• Predictive models to assess individual risk and guide preventive measures
• Wearable technology for continuous monitoring of at-risk patients

What impact might these advancements have on patient care? As research progresses, we can anticipate more targeted and effective treatments, improved risk assessment, and potentially, the ability to prevent pneumothorax in high-risk individuals. These advancements hold the promise of not only improving outcomes but also enhancing the quality of life for those living with the risk of pneumothorax.

The journey of understanding and managing pneumothorax continues to evolve. From recognizing symptoms to exploring cutting-edge treatments, the field offers both challenges and opportunities. As research advances and our knowledge deepens, individuals affected by pneumothorax can look forward to improved care, more effective prevention strategies, and a brighter outlook for lung health.

Know the Signs of a Collapsed Lung

You may have heard of a collapsed lung, but what exactly does that mean, and how do you treat it? 

A collapsed lung, or pneumothorax, happens when air escapes from your lung and fills the space between the lung and chest wall. The lung is then not able to expand normally when you take a breath. The condition is rare but could be life-threatening, so you should seek immediate care.

Symptoms of a collapsed lung include:

• Dull, steady ache in the chest
• Pain upon inhaling
• Shortness of breath
• Chest tightness
• The sensation that you can’t draw breath
• Face turning blue due to lack of oxygen
• Very fast heartbeat

What Causes a Collapsed Lung?

Impact with Blunt Object. This is the leading cause of a collapsed lung. It can happen when playing sports where you might collide with a ball or person. A car crash can also involve an impact to the chest wherein this injury could occur.

Puncture. Any penetrating wound to the chest can puncture the lung. This could be something violent, like a knife or stab wound. It could also be the result of vigorous play, such as a pencil stabbing. An aerosol can exploding could also cause a collapsed lung.

Disease. Diseases such as emphysema and COPD can lead to a collapsed lung. Certain infections, such as pneumonia, can be the culprit, too.

Spontaneous pneumothorax. Very tall and typically very thin male young adults are especially prone. For these people, the pneumothorax can just occur; you don’t need to be hit in the chest or have other trauma for it to happen.    

Hospital procedures. In the hospital, some medical procedures, such as the insertion of a chemotherapy port to your chest, can also sometimes damage your lung.

What To Do Immediately After Injury

The most pressing concern is to make sure oxygen is flowing. Emergency services should be called immediately, and you will be administered oxygen as you are transported to a hospital.

When oxygen escapes from the lungs, they can’t function fully and properly. Supplying oxygen keeps the lungs working and helps replace some of the missing air. Psychologically, the sooner your breathing returns to a more normalized state, the sooner your body receives the signal to relax. Supplied oxygen can help the pneumothorax get smaller too. 

How a Collapsed Lung Is Treated

Treatment is determined by how much of the lung is collapsed. If just a small portion is affected, your doctor may admit you to the hospital for observation. If you have a tiny wound, it can easily seal over.

If the affected area is larger, your doctor will evacuate the air that has escaped from the lung and is gathering in the chest cavity. Each time air gets pushed out from the lung, it is then trapped and pushing against the lung. Picture your lung as a balloon, and in this case, it’s pushed against a wall. This misplaced air can also exert pressure on the heart, which is another reason to address the problem quickly.

Your doctor will explore all nonsurgical options. One of the first steps is to place a small chest tube with a suction device to evacuate the air from outside the lung.

A second course of treatment might be a patch through which your own blood can be inserted to seal the injury. Alternatively, another substance may be inserted through the chest tube to intentionally irritate the lung lining, causing it to stick together and seal up.

If the affected lung area doesn’t seal with these measures, your doctor can perform a video-assisted surgery to find where the air is escaping and repair it.

Your doctor will make the most conservative treatment choice possible, escalating only when necessary.

What To Do After Treatment

After the wound has been treated, it’s important that, for the next two to four weeks, you avoid:

• Flying on airplanes
• Scuba diving
• Playing a wind instrument
• Playing contact sports or participating in anything where a chest hit might occur

Once the injury has fully healed, you’re safe to resume these activities and your normal lifestyle.

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When Lungs Collapse | Cystic Fibrosis Foundation

I knew I had lousy lungs, but I never expected them to blow out like a tire on the highway. Before 2015, a pneumothorax (collapsed lung) was not in my medical vocabulary and I associated it only with action movies and the Discovery Health Channel, not with me or cystic fibrosis. I am now far too familiar with the signs, treatments, and recovery stages of a spontaneous lung collapse — I might even call myself an expert.

In 2015, I was a senior in high school when my left lung spontaneously collapsed, and I was vividly reminded that life is unpredictable. Fast forward to this summer (a rising senior in college) and my body reminds me, once again, that the unexpected can happen. This time it was my right lung that gave out, randomly, or as my doctor said, “dropped.” Both experiences were complicated and resulted in two-week hospital stays, many chest tubes, and required lung surgery to stop the air leak.

Me waking up in the ER after my chest tube placement. July 2018.

Before my first one, I knew absolutely nothing about pneumothoraces, or their relationship with CF, and that is why I was so afraid when it happened. I did not even know what the symptoms of a collapsed lung were. Was it the sudden inability to breathe? Nope! I could still breathe, walk, and talk when one lung was collapsed. I felt chest discomfort, tightness, shortness of breath, shoulder pain, and exhaustion — symptoms that I had experienced before with CF, but not all at once.

In 2015, it took me a few hours of feeling weird before I called my doctor who told me to go to the emergency room (ER) for an X-ray.

This summer, I ended up working an entire shift before realizing something was seriously wrong and telling my doctor I needed a chest X-ray. Those experiences taught me the importance of listening to my body and not ignoring the warning signs. If something feels wrong, something probably is wrong.

I later learned that CF did not cause the collapses directly. They were caused by a pulmonary bleb rupturing. Blebs are small air blisters that can develop on the lung’s surface — anyone can develop them! Although CF does not cause them, it is thought to provoke them because of the constant inflammation and irritation of the lung tissue. A bleb can pop randomly, leaving a hole in the lung lining — yikes! This is what happened to me, twice.

Because a thoracic surgeon repaired my pneumothorax, I was sent to the thoracic floor of the hospital to recover. I had to be my biggest advocate there as the nurses and doctors, who did not specialize in CF, were making decisions about me and my lungs.

This was difficult when I was on pain meds and wanted to sleep all day, but I used my best judgment and challenged the doctors’ orders if they seemed wrong. CF lungs are not regular lungs. They often need extra attention or care. In my experience, the standard procedure is not always the right procedure for people with CF.

After I was finally allowed outside post lung surgery. July 2018.

The two lung collapses were very low points in my 21-year life, mainly because of the uncertainty and fear I felt. The immobility and constant pain I dealt with was a nightmare at the time but left me with a lasting appreciation of my healthier days. It’s funny how hardship can lead to a new, uplifting perspective. If nothing else, at least now I have matching scars on both sides!

Join the conversation on Facebook.

Hogan was diagnosed with cystic fibrosis at age three and has been smiling, laughing, and coughing her entire life. She is a strong believer in the benefits of optimism and loves spreading enthusiasm and positivity. Hogan grew up on the coast of Maine and recently graduated from the University of Vermont. She is the leader of her Great Strides team, “Hogan’s Heroes,” and spends her springs fundraising for CF. Reach out to her on the Hogan’s Heroes team Facebook page.

Our difficult ones

The death toll from the COVID-2019 disease caused by the new coronavirus SARS-CoV-2 has exceeded seven thousand people worldwide. As a rule, all these people died from the symptoms of pneumonia, an acute respiratory disease that has been known for almost two centuries. At the request of N + 1 , pulmonologist Vasily Shtabnitsky spoke about what pneumonia is, what it happens, how it proceeds and what exactly threatens the body.

What are the types of pneumonia?

“Classic”, or bacterial, pneumonia was scientifically described as early as the 19th century, and around the same time, the first known pathogens, pneumococci, were isolated. In this type of pneumonia – also called “typical pneumonia” – an infection in the lower respiratory tract provokes inflammation and fluid accumulation in the alveoli, exudate forms, and respiratory failure occurs.

Closer to the middle of the twentieth century, SARS was described, which can be provoked by many pathogens – chlamydia, mycoplasmas, legionella and viruses. It does not give a clinical picture characteristic of the “classics”, it may not be accompanied by high fever, wheezing, sputum with blood. In its course, general signs of intoxication and a dry cough may prevail. On radiographs, as a rule, only an indistinct infiltrate is visible.

A discussion began among the medical profession, which continues to this day, about whether the virus can cause pneumonia. The classical mechanism of pneumonia is associated with certain properties of bacteria, with the substances they secrete and with the immune response that they provoke. Against this background, viruses either do not cause pneumonia at all, or, if they do, then atypical.

Pneumonia of this type can be called interstitial, since the fluid is formed not in the alveoli, but in the interstitium, that is, in the connective tissue space between them. This contributes to the formation of a non-specific picture, when “everything is fine” in the alveoli. Such inflammation can only be seen with the help of a CT scan – the so-called “frosted glass” or some other interstitial pattern is visible there.

The outbreak of severe acute respiratory syndrome (SARS) in the early 2000s, followed by the h2N1 flu pandemic in 2009-10, caused many deaths. People were dying from what was called viral pneumonia and, in some cases, acute respiratory distress syndrome (ARDS).

What is this syndrome?

ARDS is a non-specific lung injury that can develop in response to various stimuli – infection, injury, inhalation of some substance, such as poison gas, say, chlorine, used in the First World War.

In order to explain its effect, it is necessary to talk about the structure of the lungs. This is a system that transfers oxygen from air to a liquid, that is, to the blood. It is necessary to drive oxygen into the aquatic environment, and at the same time prevent the liquid from filling the alveoli. To do this, there are structures in the lungs – the endothelium and the alveolar-capillary membrane, which keep fluid from passing into the alveoli.

In ARDS, these structures begin to collapse, they no longer hold back the fluid, and it immediately, along the pressure gradient, fills the alveoli. The so-called non-cardiogenic pulmonary edema is formed.

Acute respiratory distress syndrome (ARDS)

ARDS develops extensive inflammation of the lungs, which leads to severe respiratory failure. This condition appears not only with pulmonary pathologies, it can be the result of many life-threatening conditions.

Conditions that have a direct damaging effect on the lungs include pneumonia, lung injuries. When they violated the integrity of the epithelium of the bronchi and alveoli. This contributes to blockage of the bronchi, subsidence of lung areas, the development of pulmonary edema (alveolar and interstitial).

The most common conditions in which the lungs are indirectly affected are severe infections (sepsis, peritonitis), acute pancreatitis, severe trauma, massive blood transfusions. With them, the epithelium of the pulmonary capillaries is damaged, which leads to the release of plasma and blood cells into the interstitium. As a result, the interalveolar septa become thicker, gas exchange becomes more difficult. In the future, severe disturbances in the microcirculation of the lungs develop, the fluid enters the alveoli.

Symptoms of ARDS include a feeling of lack of air, frequent wheezing, cyanosis, tachycardia, arterial hypertension, they are often accompanied by anxiety and agitation. ARDS develops within hours or days after exposure to a damaging factor. Usually it is accompanied by a violation of the work of other organs (multiple organ failure).

Source

The direct damaging effect of the virus plays some role in this. It seems to multiply in the alveolar epithelium, and the infected cells cease to perform their function. In addition, apoptosis, programmed cell death, is activated in cells; they can be destroyed by macrophages.

But the body’s immune response also plays a very important role. The virus does not just multiply in cells, it leaves its antigen on the surface of the cell. By this antigen, the cells of the immune system recognize her as sick. The massiveness of cell damage to viruses is also important here, and also, perhaps, the absence of some other, more targeted tools of immunity. When more targeted immunity fails, the “big artillery” kicks in to help the virus destroy the lungs.

This does not mean that if we turn off immunity, the patient will be fine, and this does not mean that, say, immunodeficient persons will not suffer from such severe viral pneumonia. But, in general, the mechanism is mainly associated with the immune response.

This happens not only in the case of pneumonia, but also, for example, in sepsis and septic shock. The severity of a person’s condition can be affected not only by infection of the blood with bacteria, but by the reverse immune response of our body.

Now, if possible, explain step by step: bacteria enter the respiratory system and begin to multiply there, and then?

Bacteria enter the lungs and continue to multiply there. Inside the alveoli in the lungs there are so-called alveolar macrophages. They get a bacterium, destroy it, and expose its antigens to other immune cells that start to study them, and at the same time throw out a lot of mediators that attract other cells.

Other macrophages come to the focus of inflammation, neutrophils come there – this is already an “atomic weapon” of the immune system, destroying everything to zero. B- and T-lymphocytes come to the focus of inflammation. B-lymphocytes produce immunoglobulins that bind to bacterial antigens, which helps recruit other immune cells to attack. The role of T-cells here is slightly less, they are able to destroy bacteria directly.

Bacteria are destroyed, toxic substances are released, and this leads to an increase in temperature. The arachidonic acid system is activated, prostaglandins are formed, which increases blood flow to the site of inflammation, and the rate of biochemical reactions increases. Further, if the body is strong, then it destroys it all itself and does not allow the infection to spread.

If the body is not strong, bacteria can multiply and move to other organs. Sepsis can develop: this is a condition in which bacteria enter the bloodstream. A massive release of some bacterial toxins can lead to the development of a systemic reaction: to the development of hypotension, shock.

This is how pneumonia triggered by a bacterial infection works. But the mechanism is about the same in the case of viruses. However, compared to a bacterium, a virus is more generalized, it infects many tissues, and viruses are more difficult to fight, they do not have a cell wall that can be destroyed.

The virus is constantly infecting new cells, and they themselves become the source of a new virus. Therefore, several other mechanisms of immunity work here – just T-cells, macrophages, antibodies.

Is it true that in severe pneumonia the lungs stop oxygenating the blood and the person dies of suffocation?

In the case of bacterial pneumonia, the structures are destroyed, the alveoli are filled with an infiltrate containing cell debris, bacteria, cells of the immune system. Essentially, the lung becomes a fluid-filled sponge. The larger part of the lung is occupied by the infiltrate, the worse the person breathes. At some point, he simply develops critical respiratory failure.

This may be accompanied by a violation of cardiac activity, cerebral edema may form. But a decrease in the concentration of oxygen in the blood is inevitable, and it can fall to a level incompatible with life.

And this process can be stopped with antibiotics?

Yes, drugs that kill all bacteria. The immune system will simply have to clear these dead fields with macrophages, and the patient will have to wait until the lungs are cleared.

But antibiotics are not a 100% guarantee against ARDS. I myself have seen such situations many times: with intensive treatment with antibiotics, a large number of bacteria can be destroyed, which leads to the release of a large amount of toxins into the bloodstream.

And how does it work in the case of viruses, when there are no foreign cells?

There are cells infected with a virus. Each virus exposes its antigens to the surface of the cell, and it becomes a target for our immune system. The immune system begins to fight this cell, to destroy it.

It happens that a virus in the lungs has infected many cells, but the immune system did not work well at first. Then, in response to a massive infection, the body may overreact and destroy too many cells. From such a “nuclear war” at the level of the immune system, ARDS can also develop.

It is not entirely clear why some viruses cause more ARDS than others, but the “old” SARS virus and avian influenza virus, and even more so the new coronavirus, can cause such a reaction.

You mentioned that viral pneumonia has a different picture, that it is interstitial pneumonia. What’s the difference?

The lungs consist of air “sacs” – alveoli, and between the groups of these sacs is the interstitium. This can be compared to bunches of grapes, which are each packed in a separate bag. If you cut a tangerine, then between the lobules we will find large partitions – just like that between the alveoli there is this intermediate interstitial space.

In bacterial pneumonia, the infiltrate can fill the alveoli, while in viral pneumonia it enters the interstitial space, and this can cause serious respiratory failure. At the same time, nothing can be seen on the x-ray, but there will be some slight changes on the CT scan. With coronavirus pneumonia, this is what happens: severe shortness of breath, signs of respiratory failure – and slight changes in computed tomography.

Is there any way to stop the slide into pneumonia in the early stages? In the case of a bacterial infection, you can drink antibiotics, but in the case of a virus?

This is a different case. There are no proven ways to prevent pneumonia, drugs for specific antiviral therapy in Russia, and we cannot recommend anything yet.

The Chinese have described the use of chloroquine, an antimalarial drug they claim has an antiviral effect. But these data need to be investigated. Antibiotics prophylactically, I think, should be prescribed, because no one has canceled a secondary bacterial infection. But, apparently, it does not play a big role.

Hormones don’t seem to be working. Antiviral drugs probably don’t work either, although various options have been tried, both anti-flu drugs and anti-HIV drugs. (For more on Chinese doctors’ attempts to use these and other drugs, see our material “At the bottom of the first-aid kit.” – Note N + 1 .)

What happens in an emergency when the lungs stop working? You can turn on the ventilator, but this requires that the lungs themselves absorb oxygen. What if they are filled with liquid?

To combat hypoxemia in patients, there are many different methods: you can manually inflate the lungs, even sticky alveoli can be expanded. All this works for the time being. But, probably, one of the best for today is ECMO, extracorporeal membrane oxygenation.

We create a special membrane through which blood flows. The membrane allows the blood to be oxygenated in the same way that it is saturated when it passes through the lungs. That is, we create, as it were, artificial lungs, such gills.

This may save the person, although not always. Just last year, one of the randomized trials on ECMO ended, and it did not show a reduction in the risk of death in patients with ARDS, although previous studies showed it. And yet, some patients recover very quickly after ARDS, it does not give one hundred percent mortality.

In general, you need to understand that when a patient is in such a critical condition that ECMO is required, then, as a rule, the situation is not limited to the lungs alone. He develops multiple organ failure. We’re saving lungs, and his kidneys are failing. Save the kidneys – brain loss begins.

Can the lungs recover, can a person return after ECMO?

We have stem cells that can regenerate the lungs to some extent. There are, of course, certain “buts”. New lungs cannot grow, but the epithelium can change, the membrane can recover.

There are several scenarios for ARDS. When favorable, the cells begin to regenerate. But in an unfavorable scenario, the basement membrane dies and instead of regeneration, fibrosis begins, when connective tissue begins to grow instead of cells. This is not fatal, but with fibrosis, lung function is impaired due to the fact that the architecture of the alveoli, the pulmonary lobe, is lost.

But at the stage when you have to use mechanical ventilation, is it still possible to restore health?

Perhaps, of course. According to statistics, at least 50 percent of patients survive. In some centers, I think, with super-expertise, super-elaborated protocols, mortality is no more than 20-25 percent of cases.

How long can a person live on mechanical ventilation?

This period is not limited – if there is no damage to the lungs, a person can live on a ventilator for life. But usually regeneration occurs somewhere in a month.

In other words, in the absence of antiviral agents, in the fight against viral pneumonia, we can only rely on our own immune system? Hoping that she will crush the infection in time and not kill her master in the process?

Yes. But the scenario for most cases of a new coronavirus infection is as follows: 80 percent of the sick suffer it in a mild form, 15 percent in a moderate form. In both situations, as a rule, mechanical ventilation is not required. And only due to the most severe cases – this is 5 percent of the sick – basically, the mortality rate is growing.

Are these people whose immune system is not working properly – at the wrong time or too much?

Apparently, it’s a matter of age. The role of angiotensin receptors is discussed, because in hypertensive patients the density of these receptors in the lungs is greater, and they are the target for the virus – with a large number of these receptors, the effect of the virus is enhanced. But this is only a theory, and the discussion about why hypertensive patients are at risk continues. Maybe this is due to comorbidity, concomitant diseases, or maybe, indeed, because of these receptors.

From a doctor’s point of view, how important is it to know whether a patient is infected with the coronavirus or not? Does it change anything in the practice of treatment?

I think not in general. It is clear that all sorts of epidemiological measures will have to be taken. Proper triage and isolation of patients is very important. But the tactics of treatment it changes slightly.

If we test negative for a bacterial infection, we may choose not to prescribe antibiotics to reduce the burden on the body. We can prepare a ventilator for the patient. Early intubation, connection to a ventilator is one of the methods for preventing severe ARDS. It is believed that in this case, ARDS flows more easily than if you give him a few days of spontaneous breathing.

What advice would you give to people who are beginning to feel like something is wrong with them? When they don’t have a high fever, but they cough. Either they sit at home, or run for a fluorography, or something else. How to behave in this situation?

If a person does not have risk factors associated with coronavirus infection – this is age 60-65 years and older, hypertension, cardiovascular disease, diabetes mellitus, a number of other concomitant diseases – if this is a generally healthy young person and he feels relatively well, he will most likely have symptoms like a common cold.

You can notify the clinic. Call, say: I have a cold, consult. If they say to come, come. But I wouldn’t.

Because now staying at home is an additional measure to prevent the spread of infection. That is, if a person feels sick, he should isolate himself as much as possible. It is most important. I cannot insist that everyone call the clinic and demand the arrival of a doctor. Because the resources of doctors are very limited, especially during the epidemic.

But it would be right to notify the clinic and find out about the red flags. This is increasing shortness of breath, constantly high fever, weakness that prevents movement, sputum with blood. These bad symptoms are a reason to call an ambulance to go to the hospital.

But 8 out of 10, even 9 out of 10 people will have a mild illness. And you just need to isolate yourself, try not to infect anyone, remember that the majority of the sick – according to Chinese data – are clusters in the family. When one person in a family gets sick, the whole family gets sick. It is difficult to isolate a family because a person is contagious even before symptoms appear. But, for example, if guests, weddings, and other family events are planned, it is better to postpone them to the post-epidemic threshold.

Wash your hands, wash your face, minimize meetings with people, work remotely if possible, do not use public transport, walk, or now it is possible to bike, or take a car or taxi. Don’t shake hands. Just stop shaking hands altogether. Well, try not to use common things, such as a common mug somewhere in the office. Everything must be individual.

Well, at the first signs of SARS, stay at home and do not go anywhere in any case until a negative result for coronavirus infection is obtained.

Text prepared by Andrey Ukrainskiy

First Aid | VCERM them. A.M. Nikiforov EMERCOM of Russia in St. Petersburg

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The ability to provide first aid is an elementary but very important skill. In an emergency, he can save someone’s life. Here are 10 basic first aid skills. In this section, you will learn what to do in case of bleeding, fractures, poisoning, frostbite, and other emergencies. You will also learn about common mistakes that can put the victim’s life in serious danger.

First aid is a set of urgent measures aimed at saving a person’s life. An accident, a sudden attack of illness, poisoning – in these and other emergencies, competent first aid is needed.

According to the law, first aid is not medical – it is provided before the arrival of doctors or the delivery of the victim to the hospital. First aid can be provided by anyone who is at a critical moment next to the victim. For some categories of citizens, first aid is an official duty. We are talking about police officers, traffic police and the Ministry of Emergency Situations, military personnel, firefighters.

First aid algorithm

In order not to get confused and competently provide first aid, it is important to follow the following sequence of actions:

1. Make sure you are safe and do not put yourself in danger when giving first aid.
2. Ensure the safety of the victim and others (eg, remove the victim from a burning car).
3. Check for signs of life (pulse, respiration, pupillary reaction to light) and consciousness. To check for breathing, you need to tilt the victim’s head back, bend over to his mouth and nose and try to hear or feel breathing. To detect the pulse, it is necessary to attach the fingertips to the carotid artery of the victim. To assess consciousness, it is necessary (if possible) to take the victim by the shoulders, shake gently and ask a question.
4. Call specialists: 112 – from a mobile phone, from a landline – 03 (ambulance) or 01 (rescuers).
5. Provide emergency first aid. Depending on the situation, this may be:
   – restoration of airway patency;
   – cardiopulmonary resuscitation;
   – stop bleeding and other measures.
6. Provide the victim with physical and psychological comfort, wait for the arrival of specialists.

CPR

Artificial lung ventilation (ALV) is the introduction of air (or oxygen) into the respiratory tract of a person in order to restore natural ventilation of the lungs. Refers to elementary resuscitation measures.

Typical situations requiring mechanical ventilation:

• car accident;
  water accident;
  electric shock and others.

There are various ways to ventilate. Mouth-to-mouth and mouth-to-nose artificial respiration is considered the most effective in providing first aid to a non-specialist.

If no natural respiration is detected on examination, immediately administer artificial respiration.

Mouth-to-mouth artificial respiration technique

1. Maintain a clear upper airway. Turn the head of the victim to one side and use your finger to remove mucus, blood, foreign objects from the oral cavity. Check the victim’s nasal passages, clean them if necessary.
2. Tilt the victim’s head back while supporting the neck with one hand.

   Do not change the position of the victim’s head in case of a spinal injury!

3. Place a tissue, handkerchief, piece of cloth, or gauze over the victim’s mouth to protect yourself from infections. Pinch the victim’s nose with your thumb and forefinger. Inhale deeply, press your lips tightly against the victim’s mouth. Exhale into the victim’s lungs.

   The first 5-10 breaths should be fast (20-30 seconds), then 12-15 breaths per minute.

4. Monitor the movement of the victim’s chest. If the victim’s chest rises when inhaling air, then you are doing everything right.

Chest compressions

If there is no pulse with breathing, chest compressions should be performed.

An indirect (closed) heart massage, or chest compression, is the compression of the muscles of the heart between the sternum and the spine in order to maintain the circulation of a person during cardiac arrest. Refers to elementary resuscitation measures.

Attention! It is impossible to carry out a closed heart massage in the presence of a pulse.

Chest Compression Technique

1. Lay the victim on a flat hard surface. Do not perform chest compressions on a bed or other soft surfaces.
2. Locate the affected xiphoid process. The xiphoid process is the shortest and narrowest part of the sternum, its end.
3. Measure 2-4 cm upward from the xiphoid process – this is the point of compression.
4. Place the base of your hand over the compression point. In this case, the thumb should point either to the chin or to the stomach of the victim, depending on the location of the resuscitator. Place the other hand on top of one hand, fold your fingers into the lock. Pressing is carried out strictly with the base of the palm – your fingers should not come into contact with the victim’s sternum.
5. Perform rhythmic chest thrusts strongly, smoothly, strictly vertically, with the weight of the upper half of your body. Frequency – 100-110 pressures per minute. In this case, the chest should sag by 3–4 cm.

For infants, chest compressions are performed with the index and middle fingers of one hand. Teenagers – with the palm of one hand.

If ventilatory support is given concurrently with chest compressions, every two breaths should be alternated with 30 chest compressions.

Harm: chest compressions can break ribs, therefore broken bones can easily damage lungs and heart.

Correct: chest compressions are performed only after you have made sure that the victim has no pulse and breathing, and there is no doctor nearby. While one person is doing a heart massage, someone else must call an ambulance. Massage is performed in rhythm – 100 compressions in 1 minute. In the case of children, chest compressions are performed with the fingers in a different rhythm. After the heart starts, start performing artificial respiration. Alternative method: 30 compressions and 2 breaths, then repeat compressions and 2 breaths again.

In the event of an accident, do not remove the victim from the car and do not change his position

Harm: death most often occurs with trauma or fracture of the spine. Even the most insignificant movement, caused by helping the victim to lie down more comfortably, can kill or make a person disabled.

Correct: call an ambulance immediately after an injury if there is concern that the victim may have a head, neck or spine injury. At the same time, monitor the patient’s breathing until the arrival of doctors.

Fractures

Fracture – violation of the integrity of the bone. A fracture is accompanied by severe pain, sometimes fainting or shock, bleeding. There are open and closed fractures. The first is accompanied by a wound of soft tissues, bone fragments are sometimes visible in the wound.

Fracture First Aid Technique

1. Assess the severity of the victim’s condition, determine the location of the fracture.
2. If there is bleeding, stop it.
3. Determine if it is possible to move the victim before the arrival of specialists.

   Do not carry or change position in case of spinal injury!

4. Immobilize the bone in the area of ​​the fracture – immobilize. To do this, it is necessary to immobilize the joints located above and below the fracture.
5. Apply splint. As a tire, you can use flat sticks, boards, rulers, rods, etc. The tire must be tightly, but not tightly fixed with bandages or plaster.

For a closed fracture, immobilization is done over clothing. With an open fracture, you can not apply a splint to places where the bone protrudes outward.

Stopping bleeding with a tourniquet can lead to limb amputation

Harm: squeezing of the limbs is the result of incorrect or unnecessary application of the tourniquet. Tissue necrosis occurs due to a violation of blood circulation in the limbs, because the tourniquet does not stop the bleeding, but completely blocks the circulation.

Correct: Apply a clean cloth or sterile gauze dressing to the wound and hold it in place. Until the doctors arrive, this will be enough. Only with severe bleeding, when the risk of death is higher than the risk of amputation, is it permissible to use a tourniquet.

Tourniquet application technique

1. Apply a tourniquet to clothing or padding just above the wound.
2. Tighten the tourniquet and check for vascular pulsation: the bleeding should stop and the skin below the tourniquet should turn pale.
3. Bandage the wound.
4. Record the exact time the tourniquet was applied.

A tourniquet may be applied to limbs for a maximum of 1 hour. After its expiration, the tourniquet must be loosened for 10-15 minutes. If necessary, tighten again, but no more than 20 minutes.

In case of bleeding from the nose, do not tilt your head back or lie on your back

Harm: The pressure rises sharply if you throw your head back or lie on your back during a nosebleed. Blood can enter the lungs or cause vomiting.

Correct: Keeping your head straight will speed up the pressure reduction. Apply something cold to your nose. Close the nostrils alternately for 15 minutes each, with your index finger and thumb. Breathe through your mouth during this time. Repeat this technique if the bleeding does not stop. If bleeding continues, seek immediate medical attention.

Use of drugs that cause vomiting

Harm: Drugs that induce vomiting, burn the esophagus and contribute to poisoning by vomit when inhaled.

Correct: call an ambulance if you suspect poisoning. Describe the symptoms of poisoning by phone and remember the manipulations and actions that the dispatcher will recommend to you. Do not evaluate the severity of poisoning on your own and do not look for advice on the Internet – intoxication with vitamins or alcohol is very dangerous. A lethal outcome is possible in a short time if you do not seek medical help in time.

Fainting

Fainting is a sudden loss of consciousness due to a temporary interruption of cerebral blood flow. In other words, it is a signal to the brain that it lacks oxygen.

It is important to distinguish between normal and epileptic syncope. The first is usually preceded by nausea and dizziness.

The pre-fainting state is characterized by the fact that a person rolls his eyes, becomes covered with cold sweat, his pulse weakens, his limbs become cold.

Typical syncope situations:

• fright
• excitement
• stuffiness and others

If the person has fainted, put him in a comfortable horizontal position and provide fresh air (unbutton clothes, loosen belt, open windows and doors). Sprinkle cold water on the face of the victim, pat him on the cheeks. If you have a first-aid kit on hand, give a cotton swab moistened with ammonia to sniff.

If consciousness does not return after 3-5 minutes, call an ambulance immediately.

When the victim comes to, give him some strong tea.

Do not put a spoon in the mouth of a person who is having a seizure.

And do not take out his tongue

Harm: A person in a seizure state may swallow or choke on an object that is inserted into the mouth to protect the tongue.

As correct: Seizures result in blue or violent tremors. By itself, the body cannot harm itself, and the attacks end on their own. It is better to call a doctor, and make sure that the person does not harm himself and can breathe freely. Nothing will happen to the language. A person will not swallow it, and biting the tongue is not dangerous. Lay the patient on his side immediately after the attack.

Burns

A burn is damage to body tissues caused by high temperatures or chemicals. Burns vary in degrees as well as types of damage. According to the last reason, burns are distinguished:

• thermal (flame, hot liquid, steam, incandescent objects)
• chemical (alkalis, acids)
• electrical
• beam (light and ionizing radiation)
• combined

In case of burns, the first step is to eliminate the effect of the damaging factor (fire, electric current, boiling water, and so on).

Then, in case of thermal burns, the affected area should be freed from clothing (gently, without tearing off, but cutting off the adherent tissue around the wound) and, for the purpose of disinfection and pain relief, irrigate it with a water-alcohol solution (1/1) or vodka.

Do not use oily ointments and greasy creams – fats and oils do not reduce pain, do not disinfect the burn, and do not promote healing.

After irrigate the wound with cold water, apply a sterile dressing and apply ice. Also, give the victim warm salted water.

Use dexpanthenol sprays to promote healing of minor burns. If the burn covers an area of ​​more than one palm, be sure to consult a doctor.

Treatment with iodine, rubbing alcohol, and washing wounds with hydrogen peroxide are sometimes hazardous

Harm: connective tissue is destroyed by hydrogen peroxide, thus the wound heals much longer. Alcohol, iodine and brilliant green burn intact cells and provoke a painful shock or burn on contact with the wound.

Correct way: Rinse the wound with clean water (boiled if possible), then treat the wound with an antibiotic ointment. Don’t put on a bandage or plaster unnecessarily. A bandaged wound heals much longer.

First aid for drowning

1. Remove victim from water.

   A drowning man grabs everything that comes to hand. Be careful: swim up to him from behind, hold him by the hair or armpits, keeping your face above the surface of the water.

2. Place the casualty on his knee with his head down.
3. Clean mouth of foreign bodies (mucus, vomit, algae).
4. Check for signs of life.
5. In the absence of a pulse and breathing, immediately start ventilation and chest compressions.
6. After recovery of breathing and heart activity, lay the casualty on their side, cover them and keep them comfortable until paramedics arrive.

Hypothermia and frostbite

Hypothermia is a drop in human body temperature below the norm necessary to maintain normal metabolism.

Hypothermia First Aid

1. Bring the casualty into a warm room or cover with warm clothing.
2. Do not rub the victim, let the body gradually warm up on its own.
3. Give victim warm drink and food.

Do not use alcohol!

Hypothermia is often accompanied by frostbite, that is, damage and necrosis of body tissues under the influence of low temperatures. Frostbite is especially common in the fingers and toes, nose and ears, parts of the body with reduced blood supply.

Causes of frostbite – high humidity, frost, wind, immobility. Aggravates the condition of the victim, as a rule, alcohol intoxication.

Symptoms:

• feeling cold
• tingling in the frostbitten part of the body
• then – numbness and loss of sensation

Frostbite First Aid

1. Keep victim warm.
2. Remove any frozen or wet clothing from him.
3. Do not rub the victim with snow or a cloth, as this will only injure the skin.
4. Wrap the frostbitten area of ​​the body.
5. Give victim hot sweet drink or hot food.

Poisoning

Poisoning is a disorder of the body’s vital functions resulting from the ingestion of a poison or toxin. Depending on the type of toxin, poisoning is distinguished:

• carbon monoxide
• pesticides
• alcohol
• drugs
• food and other

First aid measures depend on the nature of the poisoning. The most common food poisoning is accompanied by nausea, vomiting, diarrhea and stomach pain. In this case, the victim is recommended to take 3-5 grams of activated charcoal every 15 minutes for an hour, drink plenty of water, refrain from eating and be sure to consult a doctor.

In addition, accidental or intentional drug poisoning and alcohol intoxication are common .