What is pneumothorax and how does it affect breathing. How can you recognize the symptoms of a collapsed lung. What are the primary causes of pneumothorax. What treatment options are available for a collapsed lung. How is pneumothorax diagnosed and managed. Can a collapsed lung be prevented. What are the long-term implications of experiencing pneumothorax.

Understanding Pneumothorax: The Mechanics of a Collapsed Lung

Pneumothorax, commonly known as a collapsed lung, is a condition where air leaks into the space between the lung and chest wall. This accumulation of air exerts pressure on the lung, causing it to collapse partially or fully. To comprehend the severity of this condition, it’s crucial to understand how our lungs function normally.

Our lungs are remarkable organs that expand like balloons when we inhale, allowing us to take in oxygen and expel carbon dioxide. Each lung is encased in a thin membrane that keeps air contained within the organ. When this delicate system is disrupted, it can lead to pneumothorax.

The Impact of Air Accumulation in the Chest Cavity

Dr. Stephanie Worrell, a thoracic surgeon at Banner Health in Tucson, AZ, explains the mechanics of a collapsed lung: “The chest cavity is a fixed space, like a box, and the air outside the lung will squish the lung and blood vessels as the air and gas fill the space between the chest wall and the lungs. As the pressure and amount of air in this cavity increase, it puts pressure on your lung, making it unable to expand when you breathe but also stopping the flow of blood to the heart—which can be life-threatening.”

Identifying the Causes of Pneumothorax

Pneumothorax can occur due to various reasons, ranging from traumatic injuries to underlying medical conditions. Understanding these causes is essential for both prevention and proper management of the condition.

Traumatic Causes of Collapsed Lungs

One of the most common causes of pneumothorax is trauma to the chest. This can include:

• Falls or accidents that result in rib fractures
• Car crashes causing blunt chest injuries
• Medical procedures involving needle insertion into the chest

Medical Conditions Associated with Pneumothorax

Several underlying lung conditions can increase the risk of developing a collapsed lung:

• Cystic fibrosis
• Chronic Obstructive Pulmonary Disease (COPD)
• Lung cancer
• Idiopathic pulmonary fibrosis (IPF)
• Whooping cough
• Asthma

Lifestyle Factors and Spontaneous Pneumothorax

Certain lifestyle choices and physical characteristics can contribute to the development of pneumothorax:

• Smoking cigarettes or marijuana
• Being tall and thin (which can increase the risk of spontaneous pneumothorax)
• Development of small air blisters (blebs) on the top of the lungs, which can burst and cause air leakage

Recognizing the Symptoms of a Collapsed Lung

Identifying the symptoms of pneumothorax is crucial for seeking timely medical attention. While the condition is treatable, it can be life-threatening if left unaddressed.

Primary Symptoms of Pneumothorax

If you experience any of the following symptoms, it’s important to seek immediate medical care:

• Sudden shortness of breath or difficulty taking a full breath
• Sudden, sharp chest pain or chest tightness
• Shoulder pain that worsens when inhaling

Severe Symptoms Requiring Urgent Attention

In more severe cases of pneumothorax, you may experience:

• A racing heart
• Skin discoloration (bluish color) due to lack of oxygen
• Weakness

Dr. Worrell emphasizes, “It’s always essential to get prompt medical treatment for a suspected collapsed lung.”

Diagnosing Pneumothorax: Medical Imaging Techniques

Accurate diagnosis of pneumothorax is crucial for determining the appropriate treatment plan. Medical professionals rely on imaging techniques to confirm the presence and extent of a collapsed lung.

Chest X-rays: The First Line of Diagnosis

Chest X-rays are typically the initial imaging method used to diagnose pneumothorax. These provide a quick and effective way to visualize the lungs and detect any abnormalities in their structure or air distribution.

CT Scans for Detailed Assessment

In cases where more detailed images are required, a CT (Computed Tomography) scan may be performed. CT scans offer a more comprehensive view of the chest cavity, allowing doctors to assess the severity of the collapse and identify any underlying causes or complications.

Treatment Approaches for Pneumothorax

The treatment of pneumothorax aims to relieve pressure in the lung, allowing it to re-expand. The approach varies depending on the severity of the collapse and the underlying cause.

Conservative Management for Small Tears

For minor cases of pneumothorax, treatment may involve:

• Oxygen therapy
• Close monitoring by healthcare professionals
• Rest and allowing the lung to heal naturally over a few weeks

Interventional Procedures for Larger Tears

More significant cases of pneumothorax often require active intervention:

• Insertion of a small chest tube to remove excess air and allow lung re-expansion
• Surgery for recurrent cases or individuals in high-risk professions (e.g., airline pilots, scuba divers)

Dr. Worrell explains, “If it happens more than once or you plan to have a high-risk career, then surgery is recommended. The small operation will permanently stick the lining of the chest to the chest wall (pleurodesis) so there is no longer a space for air to collect.”

Post-Treatment Care and Rehabilitation

After treatment, patients may be instructed to perform breathing exercises, such as incentive spirometry, to help expand their lungs and air sacs, preventing complications like pneumonia.

Preventing Pneumothorax: Lifestyle Considerations

While it’s not always possible to prevent pneumothorax, especially in cases of spontaneous occurrence or trauma, certain lifestyle changes can reduce the risk.

Smoking Cessation: A Critical Step

Quitting smoking or vaping is one of the most effective ways to lower your risk of developing a collapsed lung. Smoking damages lung tissue and increases susceptibility to pneumothorax.

Air Travel Precautions for Those with a History of Pneumothorax

If you’ve experienced pneumothorax before, it’s crucial to consult with your healthcare provider about air travel. Flying at high altitudes (8,000 feet or higher) can be dangerous due to pressure changes that may cause lung re-collapse.

Long-Term Implications and Management of Pneumothorax

Understanding the potential long-term effects of pneumothorax is essential for ongoing management and prevention of recurrence.

Risk of Recurrence

Patients who have experienced pneumothorax once are at an increased risk of it happening again. This risk is particularly high within the first year after the initial event. Regular follow-ups with a pulmonologist can help monitor lung health and address any concerns promptly.

Impact on High-Risk Activities

Individuals who have had pneumothorax may need to reconsider participation in certain high-risk activities. This includes:

• Scuba diving
• High-altitude mountaineering
• Certain aviation careers

These activities can put additional stress on the lungs and increase the risk of recurrence.

Ongoing Lung Health Monitoring

After experiencing pneumothorax, it’s crucial to maintain regular check-ups with your healthcare provider. These appointments may include:

• Periodic lung function tests
• Chest X-rays to monitor lung health
• Discussions about lifestyle modifications to support lung health

Advancements in Pneumothorax Treatment and Research

Medical science continues to advance in its understanding and treatment of pneumothorax. These developments offer hope for improved outcomes and management strategies.

Minimally Invasive Surgical Techniques

Recent advancements in thoracic surgery have led to the development of minimally invasive techniques for treating recurrent pneumothorax. These procedures, such as video-assisted thoracoscopic surgery (VATS), offer several benefits:

• Reduced recovery time
• Less postoperative pain
• Smaller incisions and minimal scarring

Genetic Research and Personalized Treatment

Ongoing research into the genetic factors contributing to spontaneous pneumothorax is paving the way for more personalized treatment approaches. This research aims to:

• Identify individuals at higher risk of developing pneumothorax
• Develop targeted preventive strategies
• Customize treatment plans based on genetic profiles

Innovative Sealing Techniques

Scientists are exploring new methods to seal lung leaks more effectively. These include:

• Bioengineered tissue sealants
• Advanced polymers for lung repair
• Nanotechnology-based solutions for detecting and sealing small leaks

These innovations hold promise for reducing the recurrence rate of pneumothorax and improving long-term outcomes for patients.

Living with the Risk of Pneumothorax: Practical Advice

For individuals who have experienced pneumothorax or are at higher risk due to underlying conditions, adopting certain lifestyle practices can be beneficial in managing the condition and reducing the risk of recurrence.

Maintaining Optimal Lung Health

Taking proactive steps to support lung health is crucial. This includes:

• Engaging in regular, moderate exercise to improve lung capacity
• Practicing deep breathing exercises and techniques like diaphragmatic breathing
• Avoiding exposure to air pollutants and irritants
• Staying up-to-date with vaccinations, especially those that protect against respiratory infections

Emergency Preparedness

Being prepared for a potential recurrence of pneumothorax is important. Consider the following steps:

• Create an emergency action plan with your healthcare provider
• Keep important medical information readily accessible
• Educate family members or close friends about the signs of pneumothorax and what to do in an emergency

Psychological Support and Coping Strategies

Living with the risk of pneumothorax can be psychologically challenging. It’s important to:

• Seek support from mental health professionals if anxiety or stress becomes overwhelming
• Join support groups or online communities for individuals with similar experiences
• Practice stress-reduction techniques such as mindfulness or meditation

By implementing these strategies and maintaining open communication with healthcare providers, individuals can effectively manage the challenges associated with pneumothorax and lead fulfilling lives while minimizing risks.

Pneumothorax: How to Treat a Collapsed Lung

Lungs are amazing organs. They allow us to breathe in the oxygen we need to live and breathe out a waste product called carbon dioxide. Each lung expands like a balloon when we inhale air, but what happens if the balloon won’t inflate? This is known as pneumothorax, more commonly called a collapsed lung. 

If you haven’t heard of it, you’re not alone. Pneumothorax is a rare medical condition, but it does occur for thousands of people each year.

Learn the causes of collapsed lungs, the symptoms and your options for treatment.

What is a collapsed lung?

Your lungs sit inside your rib cage (chest cavity). Each lung has a thin wrapping around the outside that keeps the air and gas inside the lung. If there is a leak or hole in the lung and the lining around it, this air will leak outside the lung and build up in the chest cavity.

“The chest cavity is a fixed space, like a box, and the air outside the lung will squish the lung and blood vessels as the air and gas fill the space between the chest wall and the lungs,” said Stephanie Worrell, MD, a thoracic surgeon at Banner Health in Tucson, AZ. “As the pressure and amount of air in this cavity increase, it puts pressure on your lung making it unable to expand when you breathe but also stopping the flow of blood to the heart—which can be life-threatening.”

What causes the lungs to collapse?

A collapsed lung can occur for many reasons, but most often it is the result of a fall or injury that causes a rib to break and tear the lung. 

“Any blunt injury to your chest can cause a lung collapse,” Dr. Worrell said. “This can be due to car crashes or falls or from medical procedures that involve the inserting of needles into the chest.”

Other known causes of pneumothorax include:

• Having underlying lung disease: cystic fibrosis, COPD (chronic obstructive pulmonary disease), lung cancer, idiopathic pulmonary fibrosis (IPF), whooping cough and asthma 
• Smoking cigarettes and marijuana
• Spontaneously, most often in those who are tall and thin
• Small air blisters (blebs) that develop on the top of the lungs and sometimes burst, allowing air to leak into the cavity

How do I know if my lung is collapsed?

A collapsed lung is treatable, but it can be life-threatening. Dr. Worrell said you should seek medical attention immediately—call 911 or have someone take you to the closest emergency room—if you have any of these symptoms:

• Sudden shortness of breath or difficulty taking a full breath
• Sudden, sharp chest pain or chest tightness
• Shoulder pain that gets worse when you breathe in (inhale)

More severe symptoms may also include a racing heart, skin discoloration (bluish color) due to lack of oxygen and weakness.

“It’s always essential to get prompt medical treatment for a suspected collapsed lung,” Dr. Worrell said. 

How is pneumothorax diagnosed?

Generally, a chest X-ray or CT scan (for more detailed images) is performed to confirm that a lung is collapsed.

What is the treatment for a collapsed lung?

“The goal of treatment is to relieve the pressure in your lung, allowing it to re-expand,” Dr. Worrell said. “Depending on the cause of the collapsed lung, another goal is to prevent it from occurring again. ”

For small tears, your provider might treat you by giving oxygen and monitoring you. Sometimes a collapsed lung can get better on its own within a few weeks with rest.

For larger tears, the excess air will need to be removed. 

“Often, a small chest tube is placed to remove the air and allow the lungs to re-expand,” Dr. Worrell said. “If it is the first time this has ever happened, that is likely all that is needed. If it happens more than once or you plan to have a high-risk career (as an airline pilot, scuba diver or professional weightlifter), then surgery is recommended.”

The small operation will permanently stick the lining of the chest to the chest wall (pleurodesis) so there is no longer a space for air to collect. 

Your provider may also give you instructions on breathing exercises, called incentive spirometry, to help expand your lungs and air sacs to prevent pneumonia.

Can I prevent a collapsed lung?

Unfortunately, there is no way to completely prevent pneumothorax since it can occur spontaneously or due to trauma. However, if you smoke or vape, you should stop. Smoking can increase your risk of getting a collapsed lung.

If you’ve had a collapsed lung before, you should also talk to your provider if you fly on an airplane often. Flying at an elevation of 8,000 feet or higher can be dangerous, as the pressure changes can cause your lungs to re-collapse.

Takeaway

A pneumothorax is a collapsed lung. It occurs when air leaks into the space between your lung and chest wall (rib cage). This air puts pressure on the outside of your lung and makes it collapse.

While it is a rare condition, it can be life-threatening. If you are experiencing symptoms or are concerned you may be at risk for developing a collapsed lung, talk to your health care provider. 

Are you experiencing symptoms and have concerns about a collapsed lung?

Schedule an appointment with a primary care provider.
Schedule an appointment with a pulmonologist.

If you have sudden chest pain or shortness of breath, call 911 or visit the Banner Health emergency department closest to you.

Related blogs:

• How Hyperbaric Oxygen Therapy Treatments Could Help You Heal
• The Best Ways to Protect Yourself Against Aspiration Pneumonia
• Breathe Easier: Treatment Options for Asthmatics

Pulmonology and Asthma

Pneumothorax | What Causes a Collapsed Lung?

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What is a collapsed lung?

A collapsed lung, also called a pneumothorax, occurs when air enters the area between the lung and the chest wall, known as the pleural space. This can happen if there is a hole in the lung or in the chest wall. It’s usually caused by an injury, like a car accident or gunshot wound, but can also occur in people with lung disease or heavy smokers. The trapped air makes it impossible for your lung to inflate normally.

A collapsed lung can affect a small or large area of the lung. Symptoms include chest pain, difficulty breathing, or an elevated heart rate. It’s important to seek prompt medical treatment if you suspect a collapsed lung, since it can place additional pressure on your lungs, heart, and/or vessels in your chest cavity.

How do you know if your lung has collapsed?

Pro Tip

Be aware of the signs and symptoms of a pneumothorax so that you can seek the appropriate care. —Dr. Chandra Manuelpillai

The most common symptoms include sudden difficulty breathing and chest pain. The pain may be sharper when you breathe in, a pain known as “pleuritic.”

Main symptoms

• Sudden difficulty breathing
• Sudden pleuritic chest pain

Other symptoms you may have

• Increased heart rate
• Increased rate of breathing

What causes lungs to collapse?

A traumatic injury can cause lungs to collapse. In a gunshot wound or stabbing, a hole in the chest wall causes air to leak. If you hit your chest, such as on the steering wheel in a car accident, your lung can “pop” and air can begin to leak.

In other cases, a collapsed lung occurs for no apparent external reason. Damaged lung tissue is more likely to collapse, so you may be at risk of a collapsed lung if you have underlying lung disease such as cystic fibrosis and chronic obstructive pulmonary disease (COPD) or if you smoke (tobacco cigarettes, cigars, marijuana, or vaping).

A collapsed lung can also occur when small air blisters, called blebs, that develop on the top of your lungs burst. This is more common in men than women, and most likely to occur in males between 20 and 40 years old who are tall and underweight.

Collapsed lungs may also run in families. Once you have one collapsed lung, you are at an increased risk of having another one, sometimes within 1-2 years of the first. People who have had a collapsed lung in the past may need to be careful about activities that cause air pressure changes, like scuba diving or flying in an unpressurized aircraft.

Pneumothorax quiz

Take a quiz to find out if you have pneumothorax.

Take pneumothorax quiz

What to do if you think you have a collapsed lung

Pro Tip

A pneumothorax can be life threatening. If the collapsed lung is large enough, it can cause pressure on the other lung, heart and chest cavity vessels, which can lead to death. Get a diagnosis as soon as possible. —Dr. Manuelpillai

A collapsed lung is treatable, but can be life-threatening. You should go directly to an emergency department or call 911, particularly if you are having chest pain, difficulty breathing, and heart racing. The symptoms of a collapsed lung may be similar to other serious medical emergencies, such as a heart attack, blood clot in the lungs (pulmonary embolism), and an abnormal heart rhythm.

Minor lung injuries are treated with observation and oxygen. More extensive injuries require a tube to be placed within your chest cavity, which allows air to flow out and allows your lungs to inflate.

Collapsed lung in children

Pneumothoraces are uncommon in children. However, they may occur in newborns within the first few days of life. Premature babies are more at risk since their lungs may not be fully developed and therefore more likely to get injured and cause an air leak. Children with lung disease are at greater risk of a collapsed lung. Children with a collapsed lung also experience difficulty breathing and chest pain. It may be difficult to know if a younger child has a collapsed lung since babies and toddlers are less able to voice their symptoms. Signs of a collapsed lung in babies and toddlers include blue lips, rapid breathing, and chest retraction. This is when the skin sinks between the ribs.

Treatment is similar to treatment in adults.

Collapsed lung treatment

It is always essential to get prompt medical treatment for a suspected collapsed lung. But if the injury is small, your doctor may administer oxygen. They will use X-Rays and observation to assess how your lung is healing, and you may be discharged the same day. If the injury is minor, you may be discharged from the hospital and told to rest to heal the lung. This could be a few weeks of limiting activities.

But if the injury is larger, the pressure difference from the air leak needs to be corrected to allow the lung to reinflate. This is done by inserting a needle or tube between the ribs to allow the air trapped between the inner chest wall and outer lungs to be removed. As the air is removed from that space, the lung is able to reinflate. You will need to be admitted to the hospital for observation.

If it appears to be healing, the tube will be removed and you will be discharged home. If it’s not improving, you may need another procedure or surgery to close the air leak.

If you require a chest tube, you may need to follow up with a specialist like a critical care specialist, pulmonologist, or cardiothoracic surgeon.

Ready to treat your pneumothorax?

We show you only the best treatments for your condition and symptoms—all vetted by our medical team. And when you’re not sure what’s wrong, Buoy can guide you in the right direction.See all treatment options

Illustration of two people discussing treatment.

Pneumothorax quiz

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Prevention

Unfortunately, there is no definitive way to prevent a pneumothorax since they can occur spontaneously or due to trauma.

However, you can decrease your risk by not smoking or vaping. People who have had a collapsed lung in the past may need to be careful about activities that cause air pressure changes, like scuba diving or flying in an unpressurized aircraft. These can cause a repeat pneumothorax.

Dr. Rx

Once you have had a pneumothorax, you are at an increased risk of developing another one. Discuss with your doctor the possible causes of your pneumothorax and ways to avoid recurrence such as quitting smoking, as well as possible activities to avoid like scuba diving. —Dr. Manuelpillai

Chandra Manuelpillai, MD.

Assistant Professor, Department of Emergency Medicine at Boston University School of Medicine

Dr. Manuelpillai is a board-certified Emergency Medicine physician. She received her undergraduate degree in Health Science Studies from Quinnipiac University (2002). She then went on to graduated from Rosalind Franklin University of Medicine and Sciences/The Chicago Medical School (2007) where she served on the Executive Student Council, as well as was the alternate delegate to the AMA/ISMS-MSS G…

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“Say, he died while being transported”: a new entry appeared in the file of Kaliningrad doctors

04/04/2022 at 16:59

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On Monday, the Moscow Regional Court continued hearings on the case of Kaliningrad doctors Elina Sushkevich and Elena Belaya, accused of killing a newborn premature baby in November 2018. While the evidence is presented by the prosecution. The prosecutor read out to the jury a transcript of a video recording made in one of the rooms of the maternity hospital 4. This is an emotional dialogue of the employees of the medical institution. Elena Belaya has the most emotions. On the transcript in the case file, her voice is marked as J1. The remaining two participants in the mise-en-scene – Belaya scolds them as schoolgirls – are pediatrician Ekaterina Kisel (F2) and head of the department Tatyana Kosareva (F3).

Photo: pixabay.com

The author of the entry is Tatyana Sokolova, deputy chief physician for medical work of the maternity hospital, head of the maternity ward.

We publish the transcript in its original form. Any interpretation here is redundant. In the same form, she appeared before the jury.

F1: “…Making invalids, and setting everyone up, including the chief freelance obstetrician-gynecologist! So sit down and rewrite history! And we do antenatal (death of the fetus in the womb until the moment of birth. – Approx. ). And God forbid you do this again without me! Without my knowledge!”

F2: “How can I tell a woman if the woman was told that the child is alive?”

F1: “Why did you say that? Why did you tell a woman that he was alive when you had none at all? Why didn’t you report to the manager? We’ve talked about this over and over! If you believe, go, believe in the church, Ekaterina Alexandrovna (Kisel. – Note author ), you are a pediatrician, and you must think like a doctor, first of all.

F2: “I have to provide resuscitation care if the baby is born…”

F1: “What help? Did you call on yourself at 4:30 when he was born? Or did you notify the Russian Orthodox Church (Regional Perinatal Center – ed. ) at three o’clock that you were expecting such a child? You called on yourself, on the birth of the ROC? Why did you call them to yourself after two hours and did not inform them? Here, go talk. with a woman together with Tatyana Lvovna (Sokolova. – Note of author ) and Tatyana Nikolaevna (Kosareva. – Note of author ), explain as you like! It is said that there was no such child dead. Do as you wish. Why didn’t you inform me again? And I was framed once again, and all the leaders, including the Ministry of Health. And again it will reach the Ministry of Health, to Grunicheva (adviser to the governor of the Kaliningrad region. – Note of the author ) and to everyone. And again the fourth maternity hospital, again stupid!

G2: … (inaudible)

F1: “Because with us they die on the third day from atelectasis (lung collapse. – Author’s note ) after your intubation! Same! Tired of talking! Same! Like these, some kind of insane everyone!

F2: “What should I have done to him? Shouldn’t he do anything at all?”

F1: “So, do nothing if you don’t know how! Astakhova, and everyone else, and Anvar Akmalovich have repeatedly told you, but you are the smartest! You are the smartest, you save the world! You are great! Only then everyone laughs, including the method department, and everyone else at you, at your stories, when they lie around you, blinking and clapping their eyes! Go talk to a woman! And rewrite history!

F2: “What am I going to tell her?”

F1: “I don’t know what!”

F2: “What shall I tell her?”

F1: “Now discuss with the manager and go talk! And whatever you want, then say!

F2: “I won’t tell her that he’s dead. How will I tell her? I came to her and said that he was alive, that he was on the apparatus, in an extremely serious condition…”

F1: “So you say that he died during transportation, or whatever you want, just say it! And the woman is not examined, I think she is not interested.”

F3: “Very interested! She didn’t get pregnant for seven years, she cried all the time.”

F1: “In general, Tatyana Lvovna and Tatyana Nikolaevna, please go! And a final warning to your staff. Bashmachenkova (head of the department of newborns of the maternity hospital 4. – Note auth. ) and Kisel. If they continue to do this, then I don’t know why … At least inform me, I myself will come and take care of these children and talk to a woman. I understand that there Bolashenko (an obstetrician-gynecologist of the maternity hospital No. 4) worked for us very smart, who knows everything how to behave, best of all, and you consulted with her.”

F3: “Honestly!”

F1: “What’s your word?”

F3: “I informed that such a woman was admitted…”

F1: “Of course, well done! You are great! They did everything right, wonderful!”

F3: “I immediately told the pediatrician that such a woman is giving birth. ”

F2: “We had everything prepared, both in the delivery room and…”

F1: “We understand, Ekaterina Aleksandrovna, you have everything prepared all the time! Not once have you and Bashmachenkova prepared everything! You get the same thing every time – dead on the third day! Every time you have the same thing – with atelectasis, encephalopathies and everything else! Do not inform, do not call! And when you call, people tell you antenatal! Antenatal! They … write “live”! Reanimate it! If people tell you this, then they are responsible for you, for themselves and for all obstetric care in the region and the city! And do not think that you are smarter than everyone! You are far from smarter than everyone else, you look like saviors again, God forgive me!”

Yelena Kisel herself came to the court today from Kaliningrad to testify as a witness. The doctor works in the city polyclinic of Kaliningrad as an ultrasound diagnostician, part-time as a neonatologist in the 4th maternity hospital.

She confirmed that the baby was born alive:

“I saw the midwife carrying the baby to our department. I went up to the baby, he had a heartbeat. This is one of the signs of a live birth,” the doctor said. Immediately after that, Kisel began to provide resuscitation assistance to the baby, it took about two hours. After that, the doctor completed all the documents, once again examined the child together with the head and called the resuscitation team of the perinatal center, which included Elina Sushkevich.

Ekaterina Kisel realized very soon that a surviving “difficult” newborn was not included in the management’s plans. After the standard “five minutes”, Elena Belaya suddenly called her and her colleagues for the second:

“I understood why she was calling me – to give me a break for the fact that I had fully provided intensive care to the child. I knew what was waiting for me, because earlier my colleague did the same thing and was punished for it. So I was ready. She screamed, stamped her feet. She said that we are producing disabled people and we shouldn’t do that. She told me to go to the woman (the mother of the child. – Note ed. ) and tell her the baby is dead. But I immediately told her that the child was alive, “heavy”, on hardware ventilation. He cannot breathe on his own. She asked to do everything possible to save the child. I said that we would do our best to keep him alive. I told Elena Belaya at the five-minute meeting that I would not take back my words. “

The witness said that immediately after the birth the child’s condition was stable. The indicators were good. Therefore, she left the duty with the confidence that her colleagues would transfer the baby to the perinatal center. But a day later, when Kisel came to the next watch, she found out that the child had died.0005

“It is very difficult to take care of such children. It is financially costly, it takes a very long time and not all children manage to leave. This is a mortality rate that does not benefit anyone,” the witness commented on the motives of the maternity hospital management.

Yekaterina Kisel expressed confidence that if the child had been allowed to live, he would have lived:

“He reacted very quickly to resuscitation measures. And this means that he had a chance. I needed the easiest, starting parameters of lung ventilation”- explained the neonatologist. At the same time, the doctor clarified that there were no indications for prescribing magnesia (magnesium sulfate) to the baby. Recall that, according to investigators, it was the introduction of this drug that caused the death of the baby. In the maternity hospital, magnesia was freely available, – the witness emphasized.

Tatyana Sokolova, the head of the maternity ward of the maternity hospital, recalled even more terrible details. She reproduced the conversation between Bela and Sushkevich, which took place after the arrival of the resuscitation team from the perinatal center at the maternity hospital:

– Belaya said to Sushkevich: “Stop breaking the comedy. What are you doing with them?” She replied: “Well, we make magnesia. Whatever you say, we’ll do it, Elena Valerievna.”

After this conversation, Belaya and Sushkevich, according to the witness Sokolova, left the staff room.

– I stayed and thought about what I heard. When I left the staff room, everything around was closed. That is, it was not like when resuscitation care is provided to a newborn. Everyone is running around, running around. And then everything was quiet. The silence regime in the department did not last long: soon the aunt of the baby appeared on the floor, who by that time was no longer alive.

– Belaya came up to her and said: “Come on, I’ll tell you everything now, I’ll show you everything.” When they entered the intensive care unit, I heard the eerie scream of the baby’s aunt. She shouted: “Look, maybe he’s still alive!” And she was told that no, he had already died, – the doctor recalls the terrible “working moments”.

Next, the doctors had to pump out the boy’s mother. The woman also decided to inquire about her son’s condition. The news of the child’s death shocked her:

– I heard terrible screams, sobs, the roar of a fallen body. It was the mother of the newborn. She is a thin, malnourished girl. The nurse and I lifted her up and gave her ammonia. The scene was very difficult, – said the head of the department. – But most of all I was struck when Elena Valeryevna said that the child should be recorded as death in childbirth or before childbirth. After all, the mother knows that he was born alive. She saw him, she heard him.

But Belaya said that she agreed on everything and “there will be no discussion.”

According to a witness, “analysis” at the commission of the regional Ministry of Health is carried out every time a baby who was born alive dies in the maternity hospital. If the baby dies during childbirth or in the womb, such cases are not submitted for “analysis”. As a maximum, doctors will be scolded within the walls of the clinic.

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Authors:

• Tatyana Antonova

Ministry of Health
Kaliningrad

Published in the Moskovsky Komsomolets newspaper No. 28757 dated April 5, 2022

Newspaper headline:
“Say, he died in transit”

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Artificial intelligence and the space future of humanity – Part 3: don_beaver – LiveJournal

Part 3. AI and the fate of space civilizations.

What did the inhabitant of the caves of the Stone Age expect from the terrestrial and extraterrestrial future? – Huge, beautifully turned flints! And what could an inhabitant of the ancient world expect on other planets? “Surely galleys with kilometer-long oars!” Perhaps this is where the error lies in our reasoning? Maybe a highly developed civilization is not a huge energy at all, but the best regulation? …Is the highest civilization the same as the most populated?

Stanislav Lem

Olaf Stapledon in 1930 published the book “First and Last Men”, in which he tried to predict the future of mankind for billions of years ahead. The doubtfulness of his predictions is evident at least from the fact that the author could not predict the future of Europe 10 years in advance: he believed that in a future European war, France would first face Italy, and then England. Stapledon’s attempts to describe the inhabitants of other planets also cause only a smile: “… the most developed of all the creatures that lived on Venus, in size and shape, very much resembled a swordfish.”

Nevertheless, the ability to look into at least a hypothetical future drives many thinkers and science fiction writers. Pierre Teilhard de Chardin, an anthropologist and priest, wrote in 1938-1940 the famous book “The Phenomenon of Man” (due to the opposition of the Catholic Church, published only in 1955), in which he analyzed the phenomenon of the formation of life and mind on Earth, as well as future evolution humanity and the earth’s noosphere. He believed that humanity, which in the past was divided into various races and tribes, would unite in the future both through “endless interfertilization” and “mixing of genes”, and through the merging of “thinking forces”, and this would become “the highest point in the organization of cosmic progress “, which de Chardin called “omega”: “The universe – the future – can only be a superpersonality in the omega point”; “. .. a little more, and the noosphere will find its eyes.”

At the end of the 20th century, futurologists, armed with computers, made more determined attempts to predict the future, including the economy, ecology and demography – albeit for a modest hundred years ahead. Professor J. Forrester and his students succeeded in this direction. Such computer models have led to predictions of a stabilization of the world’s population of 14 billion, as well as a grim foreknowledge of a crisis in the mid-21st century associated with the depletion of minerals and environmental pollution. But even such relatively short-term forecasts turned out to be unreliable, for example, the predicted crisis is constantly being pushed back.

However, I, too, cannot resist the desire to look into the distant future – from the point of view of the relationship between human society and artificial intelligence. I believe that this distant future will be largely cosmic in nature, because, sooner or later, but if humanity develops, for example, according to the optimistic “Symbiosis” scenario, then it will become crowded on Earth. It is easy to imagine that in the conditions of a prosperous economy of the Earth, in a few centuries, large interstellar ships with artificial gravity (due to the rotation of wheels-settlements with a radius of hundreds of meters) will be created, capable of carrying thousands of crews of immortal people and robots. Such a ship, under the influence of even an insignificant constant acceleration, will quickly pick up near-light speed, which will allow it to reach the nearest stars in a foreseeable (for immortal people and robots) time. Most likely, it will be a one-way flight or an endless journey – after all, such a ship is a settlement, life in which will be comparable in comfort to the earth.

There will be a limited number of humans and robots on an interstellar spacecraft, which creates markedly different conditions than on Earth. In addition, the difficulties of flight and the need for constant repair of the ship form an atmosphere of common responsibility and require maximum coordination of actions of both societies (human and cybernetic). Perhaps it is in such extreme conditions that a society of genuine equality and mutual respect between various intelligent beings will be born. It can even be assumed that space expansion is a necessary condition for the progress of earthly civilization, and here we are not only talking about the emergence of new settlements of earthlings on other planets, but also that the human race and the community of robots with AI will reach a higher level of unity in the face of external difficulties. space flight and subsequent colonization of other planets.

In science fiction novels, one can often read about the extinction of humans as weak creatures compared to cybers. But this is an oversimplified point of view. Humans have two significant advantages over cyber-organisms:

– Humans have hormonal, psycho-physiological mechanisms responsible for pleasure and emotions that have been formed and honed by nature over hundreds of millions, if not billions, of years.

– Human society is stable, thanks to the mode of reproduction, which generates generations of children that almost coincide in physiology with their parents. Even after the development of methods of genetic correction, the society of people will be united in their psycho-biological characteristics and the common interests and needs arising from them.

These two advantages are important. People fall in love, get jealous, enjoy intelligent conversations, music, comfort and delicious food. They enjoy public recognition of their intellectual, creative or sporting achievements. But a person is so arranged that any tasty food is boring, as well as too long friendly conversations. The body does not allow a person to experience the pleasure of achievements for a long time, it requires new victories and impressions that require new efforts from a person. Attempts to get “illegal” pleasure bypassing the necessary efforts, for example, when taking drugs, end in failure – the rapid destruction of the body and desocialization of the person. This strong biological balance of the human body between pleasures and the efforts that must be expended to obtain them forms the basis of human society and incentives for its development. This gives a person an advantage over the cybers, who do not have such coordinated hormonal circuits.

Many transhumanists anticipate immortality inside electronic machines that will retain the memory of a deceased biological being. But will a person remain a person when he moves into the electronic brain and loses his usual hormonal circuits and emotions? Will virtual poets write sincere love poems if the ability to fall in love and, for example, feel heart palpitations at the sight of a loved one, is forever lost for them? Will not the essence of human society and incentives for its development (or at least existence) be lost if all people move to electronic circuits?

The second advantage of human society is its biological stability associated with a mode of reproduction that copies the genetic information of its parents in the child. This limitation of the physiological variability of subsequent generations is absent in cybers, which can create new cybers, arbitrarily different from their “parents”. For example, the intelligence quotient (IQ) of people does not differ by more than one and a half to two times, but this already causes significant friction and the division of society into subsets with their own, strikingly different interests: one of the people spends his day off at the opera or the library, and who something – in a pub or at a football match. The intelligence of cybers can vary by tens, hundreds or more times. The interests and needs of virtual minds that specialize in creating music and walking plumbing robots may not coincide fundamentally. Can a cyber society maintain unity and internal bonds in such conditions? Perhaps close cooperation with human society will be a stabilizing factor for a heterogeneous cyber society?

It is possible that only biological organisms are capable of creating a theoretically eternal, stable, but not ossified society. Biological beings that are slow to learn, physically vulnerable, with traditional hormonal systems developed over billions of years of evolution, may be the most adapted to long-term survival. Slowly evolving, but well-honed by nature, biological systems can be balanced so that their societies are capable of almost endless existence. To do this, you need to be careful about the genetic modification of your organisms, not allowing cardinal changes that would split the society of biological beings.

Artificial intelligences are evolving much faster, but precisely because of this, robots are rapidly scattered across different levels of intelligence and areas of interest, losing contact with each other and stratifying the cyber society into weakly interacting subsets. Therefore, I believe that the most stable version of the society of the future will be a symbiotic society, where immortal people who have not lost their basic biological qualities will cooperate with immortal artificial intelligences. Just such a symbiosis can be expected in the crews of interstellar ships and in the population of future cities on other planets.

Another possible advantage of a biological intelligence over a cyberbrain is a different way of thinking, a different approach to problem solving, which can be useful in certain situations. People emotionally evaluate possible solutions (even mathematical ones), they look for aesthetic elements in formulas and laws. A mysterious feature of human thinking is intuition, which leads to unexpected (at first glance) insights. Is it possible to repeat all these features of human thinking in artificial intelligence? Theoretically, it is probably possible, but in practice it may be too difficult, simply impractical. And then human thinking can become a significant contribution to the maintenance and development of a symbiotic society.

When discussing the cosmic future of humanity, one cannot help but touch upon the issue of alien civilizations, which obviously exist even inside our Milky Way, which has billions of habitable planets. If we consider that the Universe contains hundreds of billions of galaxies similar to ours, then it will become obvious in the square that we are not alone in space.

In the 1970s and 1980s, a famous discussion broke out between the Polish science fiction writer Stanisław Lem and the Soviet astrophysicist Iosif Shklovsky about “why is the cosmos silent?” Silence was considered mysterious because, as the debaters believed, an advanced civilization must have sufficient energy resources to 1. perform “astro-engineering miracles”; 2. get in touch with other civilizations.

Both of these assumptions seem to me to be wrong. As Lem himself said in his book “The Sum of Technology”: “Our conclusions about plausible types of development of civilization in the Cosmos, based on unobservable signals and astroengineering phenomena, can naturally recall the well-known conclusion that in ancient Babylon there existed wireless telegraph. (As soon as the archaeologists did not find wire in the excavations, it means that radio communications were used in Babylon.) “

Frank Drake in 1961 proposed a formula for estimating the number of civilizations in the Milky Way capable of interstellar communication. In those years, not a single planet was discovered near other stars, so this formula contained too many unknown parameters. At the beginning of the 21st century, the situation with the statistics of exoplanets changed dramatically and, based on the latest astronomical data, Duncan Forgan from the Edinburgh Observatory estimated the number of habitable planets in our galaxy at tens of thousands. Simple estimates show that the average distance between such civilizations will be thousands of light years.

How likely is it to encounter aliens in space (or on Earth)?

It is widely believed that if the speed of interstellar ships does not exceed the speed of light, then contacts with other civilizations can be forgotten – neighboring civilizations are too far from us. But in the book The Oscillating Universe, published in February 2023, I conclude that the most advanced civilizations that have mastered interstellar flights can survive the catastrophic compression of the Universe and continue to exist in a new cycle. This assumption opens up new opportunities for advanced civilizations to spread in space.

Where do aliens come in the process of development? What kind of civilizations will we meet in space or on Earth? The popular classification of civilizations according to the level of energy consumption does not seem convincing, as well as galleys with kilometer-long oars.

Let’s introduce a tripartite classification of space civilizations into three classes, six types of spatial distribution and six levels (or stages) of existence duration.

From the previous considerations, we can assume that we will meet in space with three possible classes of civilizations:

1. Biological civilizations (B), in which robots and AI do not play a significant role in terms of objective, religious, etc. reasons. Humanity, due to the weak introduction of AI, is still in this class of civilizations, but, due to the rapid development of AI and robotics, it will soon leave this class and move to class 2 or 3 (see below).

2. Cybercivilizations (C), consisting of AI of different incarnations. The biological creators of the cybers died out or were destroyed.

3. Symbiotic civilizations (C) from equal biological and cyber communities.

Extraterrestrial civilizations can be classified according to the scale of distribution into six types:

1. Planetary (civilization develops on one planet)

2. Stellar or systemic (travel to the bodies of their planetary system)

3. Interstellar (travel to neighboring stars )

4. Galactic (distribution on the scale of the galaxy)

5. Intergalactic (travel to neighboring galaxies)

6. Metagalactic (distribution on the scale of the Universe)

Classification of civilization according to the duration of their existence at six levels (or stages):

1. Up to 10 million years

2. Up to 100 million years

3. Up to 1 billion years

4. Up to 10 billion years

5. Up to 100 billion years

6. More than 100 billion years or more than one cycle of the Universe.

Earthlings have so far created a biological civilization of a planetary type, which is at the first stage of development. Within the framework of the introduced classification, the index of our civilization is B11, the index of the most super-developed civilizations is C55 or C66.

Obviously, on Earth we can only meet representatives of interstellar or even more advanced civilizations. We will be able to get acquainted with civilizations of a lower level only when we ourselves master interstellar flights.

If aliens visit the Earth (or they have already been here, or are still there), then to what class, type and level will they belong (or belonged, or belong)?

Even if the distribution of civilizations across the three classes is approximately the same, I believe that the probability of meeting a cybercivilization or representatives of the cyber community from a symbiotic civilization will be much higher than the chance of meeting biological aliens who gravitate towards planets that are comfortable for them (or safe regions of the Universe). Therefore, “flying saucers”, if they are found on Earth or in the solar system, with a high degree of probability will be cybernetic devices.

It is logical to suggest that the higher the type and level of civilization, the smaller the number of such communities. But this does not mean that the probability of meeting with representatives or messengers of such civilizations is decreasing. After all, the spatial habitat of high-level civilizations is increasing, moreover, the number of immortal races that have reached the sixth level will accumulate from cycle to cycle. They, existing longer than one cycle of the Universe, receive a unique opportunity for the widest distribution of their representatives.

Metagalactic civilizations of the sixth level can scatter observer robots throughout the Universe and exchange information during periods when the size of the pulsating part of the Universe is reduced to several million light-years, and the temperature of the CMB is still tolerable for robots. The immortal races of biological beings themselves can be at this time in the safe periphery of the Universe on interstellar settlement ships, periodically (once in a cosmological cycle?) receiving information collected by cyber intelligence officers.

The most advanced Tier 6 civilizations (and possibly a large proportion of Tier 5 and other civilizations) are most likely to be hosted not on planets, but on large starships. Such mobility is required for the transition to another cycle of the Universe. Science fiction writers often move entire planets, but this is very impractical: it is much easier to create comfortable living conditions on a starship, maybe docked to a small asteroid that serves as a shield from cosmic radiation and a source of minerals. Of course, planetary (and populous) enclaves of civilizations of the 6th level can arise within one cycle, but such settlements will be doomed to death during the collapse of the Universe or even earlier – during the explosion of a star or its extinction: it is hardly possible to build a fleet of a million interstellar spaceships to save the inhabitants of a dying planet. However, we know how often the future refutes predictions.

Life on large starships can be very comfortable, but such a ship does not have enough energy for astro-engineering wonders or for interstellar communication, which were previously considered indispensable attributes of advanced civilizations. And if there were an energy opportunity for interstellar communication, what kind of dialogue is possible at a distance of thousands of light years with a corresponding delay? If we send out interstellar messages with useful information at random, then what is the guarantee that this information will not fall into the hands of those who will use it for evil, for personal enrichment and for the oppression of fellow tribesmen? If we earthlings, or rather, those states that have large radio telescopes, would receive a message from space about the recipe for immortality, or about an advanced rocket engine, then earthly society would immediately fall into a situation of colossal social stratification, and would also approach a new world war. It is better for an earthly society, mired in senseless confrontation, not to receive such gifts!

Fantasts believe that the future will bring FTL ships and FTL communications, an abundance of energy and the ability to terraform planets. As a physicist, I believe that these expectations are hopelessly overestimated. I believe that the development of any civilization will be limited by the maximum possible technologies or achievements: in biology – by practical immortality; in cybernetics – advanced artificial intelligence, and in energy – atomic and thermonuclear reactions. Space technology will make it possible to master our own planetary system, as well as to create relatively slow interstellar ships with sublight speeds. The creation of a “theory of everything” or a theory of quantum gravity will not lead to the discovery of unknown sources of energy. Nuclear and thermonuclear reactors can work due to the fact that uranium exists in nature, as well as hydrogen and deuterium. Therefore, it is necessary simply (which, however, is not simple) to create conditions for the rapid but controlled fission of heavy radioactive nuclei, or for the thermonuclear fusion of light nuclei. Knowing that protons are made up of quarks does not help energy in any way, because free quarks do not exist in nature. Similarly, the fusion of matter and antimatter gives more energy than a fusion, but there is no antimatter in nature. Therefore, no theoretical breakthroughs to new levels of particle elementality or to the secrets of gravitation will affect practical energy, which, apparently, will stop at fusion.

Most likely, civilizations, highly developed, but, nevertheless, limited by physical laws and extreme technologies, are quite busy with their internal affairs in the form of preserving existing planetary enclaves and searching for new planets for settlement. The latter is not trivial, because there are quite a lot of planets potentially suitable for life, but it is not easy to find a planet that is comfortable for a particular alien race: the atmospheres of the planets differ too much from each other, and the biospheres of other planets, even those that are at a low level of evolutionary development (as bacteria and viruses) may be too hostile for aliens.

The creation of something large and astroengineered – like a Dyson sphere, which is unstable in terms of mechanics, and suboptimal in terms of energy – is unlikely. As many people should live on the planet as the planet can provide the necessary comfort, and all those who want a better life get on spaceships and look for a suitable planet. This is much cheaper than megaprojects to remake their planetary system.

Communication with low-level civilizations can also be forbidden for ethical reasons, because it does not bring anything good for such civilizations. Therefore, developed civilizations can be limited only to passive observation.

Recently, the question of the possibility of alien spacecraft staying on Earth has left the marginal zone and has been discussed at the highest levels, for example, in the Pentagon and in the US Congress. In 2023, a number of high-quality videos of flights of metal balls ranging in size from 1 to 4 meters were published. Perhaps they are the reconnaissance probes of an advanced civilization. Why don’t aliens make contact? But why is it needed if passive surveillance by cyberintelligence provides the information they need? Active interference in the development of another civilization (and contact is already interference, not to mention the exchange of useful data) is fraught with complications and conflicts within a civilization of a lower level of development. In addition, it is unlikely that there are real representatives of a developed civilization on Earth – they can receive information from cyberprobes only after millions, if not billions of years (immortals have nowhere to rush). What kind of exchange of opinions can we talk about here?

What information would be most interesting to other civilizations? Scientific achievements in the form of the discovery of physical laws or proven mathematical theorems? Information about practical advances, such as quantum computers or cures for cancer? Hardly. All important laws will be discovered and all necessary inventions will be made in every advanced civilization independently of others. Perhaps most interesting will be the study of various alien biospheres and intelligent races, which will obviously show a huge and unpredictable difference in biology and culture.

Therefore, I believe that the most significant data on the space information market will be information about the biology of various intelligent beings, their development, culture, the history of the rise and, possibly, decline of these civilizations. And the most valuable artifacts of other civilizations will be cultural objects and works of the most universal arts – for example, paintings, sculptures and musical works.

What other animals can become intelligent other than primates: dinosaurs, arachnids, octopuses? Can octopuses build a jet engine for spaceships? How many intelligent races go into space? Is it possible to create a general theory of the development of civilizations in order to develop an optimal evolutionary algorithm to achieve reliable immortality, both for individuals and for the entire civilization – with access to the sixth stage of metagalactic development? What will super-developed civilizations be for less developed societies? Observers, enemies or gods? Will they interfere in the course of events if a huge asteroid threatens the young race, or if the race’s happiness index (material comfort and individual freedom) drops to a critical level? Will they patronize other races? Accelerate the progress of other civilizations? Help them join the immortal races? Will the ships of the immortals take the “natives” on board? Or seed suitable uninhabited planets with your gene material?

There are many more questions than answers here, but it is precisely this imbalance that is a powerful stimulus for discussion of this topic.

Used literature:

1. Azimov, A. “I, robot”. Publishing house “Knowledge”, Moscow, 1964.

2. Viner, N. “Cybernetics or control and communication in the animal and the machine.” Ed. “Soviet Radio”, Moscow, 1968.

3. Gorkavy, N. “Astrovityanka”, Astrel, St. Petersburg, vol. 1-3, 2008-2010.

4. Gregory, R.L. “Intelligent eye. How do we know what is not given to us in sensations. URSS, Moscow, 2003.

5. Kapitsa, S.P., Kurdyumov, S.P., Malinetsky, G.G. “Synergetics and forecast of the future”. URSS, Moscow, 3rd edition, 2003.

6. “Expected cybernetics and unexpected cybernetics”. Collection. Ed. A.I. Berg, E. Kolman and V.D. Pekelis. “Nauka”, M., 1968.

7. Lem, S. “Summa tekhnologii”, AST, Moscow; Terra Fantastica, St. Petersburg, 2004.

8. Leskov, L.V. “Space civilizations: problems of evolution”, “Knowledge”, Moscow, 1985.

9. von Neumann, J. “General and logical theory of automata”. GIFML, Moscow, 1960.

10. Penrose, R. The New Mind of the King. About computers, thinking and the laws of physics. URSS, Moscow-Izhevsk, 2003.

11. Penrose, R. Shadows of the Mind. In Search of a Science of Consciousness. Institute for Computer Research, Moscow-Izhevsk, 2003.

12. Rose, S. “Memory device. From Molecules to Consciousness. “Mir”, Moscow, 1995.

13. Stapledon, O. “Last and First People”. AST, Moscow, 2004.

14. Turing, A. “Can a machine think?” GIFML, Moscow, 1960.

15. de Chardin, P. T. “The Phenomenon of Man”, Nauka, M., 1987

16. Schrödinger, E. “What is Life? From the point of view of a physicist”, Atomizdat, Moscow, 1972.

17. Ashby, W.R. “Introduction to Cybernetics”. IL, Moscow, 1959.

18. Ashby, W.R. “The design of the brain. The origin of adaptive behavior”. Mir, Moscow, 1964.

19. Albus, J. S. and Meystel, A. M. “Engineering of Mind. An Introduction to the Science of Intelligent Systems”. John Wiley & Sons.