What are the symptoms of a collapsed lung. How does a pneumothorax occur. What are the different types of lung collapse. Who is at risk for developing a punctured lung. How is a collapsed lung diagnosed and treated. What is the recovery process for pneumothorax. Can a collapsed lung be prevented.

Understanding Pneumothorax: The Basics of a Collapsed Lung

A collapsed lung, medically known as pneumothorax, is a serious condition that occurs when air accumulates in the space between the lung and the chest wall. This buildup of air exerts pressure on the lung, causing it to collapse partially or completely. The term “pneumothorax” combines two Greek words: “pneumo” (related to the lungs) and “thorax” (referring to the chest).

The severity of a collapsed lung can vary, ranging from a small portion of the lung being affected to a complete collapse. Regardless of the extent, this condition requires immediate medical attention due to its potential life-threatening nature.

What happens during a pneumothorax?

During a pneumothorax, air enters the pleural space – the area between the lung and the chest wall. This space normally contains a small amount of fluid, allowing the lungs to expand and contract smoothly during breathing. When air infiltrates this space, it disrupts the normal pressure balance, causing the lung to collapse inward.

Recognizing the Symptoms of a Collapsed Lung

Identifying the symptoms of a collapsed lung is crucial for seeking timely medical intervention. The primary symptoms primarily affect breathing, but the lack of oxygen can lead to other systemic issues as well.

• Sudden, sharp chest pain that worsens with deep breathing or coughing
• Shortness of breath or difficulty breathing
• Chest tightness
• Fatigue or weakness
• Rapid heart rate (tachycardia)
• Bluish tinge to the skin (cyanosis) due to lack of oxygen

Is chest pain always present in a collapsed lung? While chest pain is a common symptom, it’s not always present. Some individuals may only experience shortness of breath or a feeling of tightness in the chest.

Types of Pneumothorax: Understanding the Different Forms of Lung Collapse

Pneumothorax can be classified into several types based on their causes and characteristics. Understanding these distinctions can help in determining the appropriate treatment approach.

Traumatic Pneumothorax

This type occurs due to direct trauma to the chest, such as from a car accident, gunshot wound, or broken rib. It can also be a result of certain medical procedures that intentionally introduce air into the pleural space for therapeutic purposes.

Primary Spontaneous Pneumothorax

This form of collapsed lung happens without any apparent cause, often in otherwise healthy individuals. It typically occurs when a small air sac on the lung’s surface ruptures, allowing air to leak into the pleural cavity.

Secondary Spontaneous Pneumothorax

Similar to primary spontaneous pneumothorax, this type can seem to appear suddenly. However, it’s usually a complication of pre-existing lung diseases such as lung cancer, asthma, or chronic obstructive pulmonary disease (COPD). Recent studies have also identified it as a potential complication of COVID-19.

Tension Pneumothorax

This is the rarest but most life-threatening form of lung collapse. It occurs when air continuously enters the pleural space but cannot escape, creating increasing pressure that can lead to cardiovascular collapse if not treated promptly.

Risk Factors and Causes of Collapsed Lung

Several factors can increase an individual’s risk of experiencing a collapsed lung. Understanding these risk factors can help in prevention and early detection.

1. Smoking: Tobacco use damages lung tissue and alveoli, making them more prone to collapse.
2. Lung diseases: Conditions like COPD, asthma, and cystic fibrosis increase the risk of pneumothorax.
3. Previous pneumothorax: Having experienced a collapsed lung in the past raises the likelihood of recurrence.
4. Tall, thin body type: This physical characteristic is associated with a higher risk of primary spontaneous pneumothorax.
5. Mechanical ventilation: Patients on ventilators are at increased risk due to potential pressure imbalances.
6. Genetic factors: Certain genetic conditions can predispose individuals to lung collapse.

Can lifestyle changes reduce the risk of pneumothorax? While not all risk factors are controllable, quitting smoking and managing underlying lung conditions can significantly reduce the risk of experiencing a collapsed lung.

Diagnosing a Collapsed Lung: Medical Procedures and Tests

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

Physical Examination

During a physical exam, the doctor will listen to your breathing with a stethoscope. Decreased or absent breath sounds on the affected side can indicate a collapsed lung.

Chest X-ray

A chest X-ray is the primary diagnostic tool for pneumothorax. It can reveal the presence of air in the pleural space and the extent of lung collapse.

CT Scan

In some cases, a computed tomography (CT) scan may be necessary to provide more detailed images of the lungs and pleural space.

Ultrasound

Bedside ultrasound is increasingly used in emergency settings to quickly diagnose pneumothorax, especially in trauma cases.

How long does it take to diagnose a collapsed lung? In most cases, a collapsed lung can be diagnosed within a few hours of symptom onset, particularly if chest X-rays are readily available.

Treatment Options for Pneumothorax: From Conservative Management to Surgery

The treatment approach for a collapsed lung depends on various factors, including the size of the pneumothorax, its cause, and the patient’s overall health status.

Observation

For small, uncomplicated pneumothoraces, doctors may opt for a “watch and wait” approach. The patient is closely monitored, and the lung is allowed to re-expand on its own.

Oxygen Therapy

Supplemental oxygen can help speed up the absorption of air from the pleural space, facilitating lung re-expansion.

Needle Aspiration

In this procedure, a needle is inserted into the chest to remove the excess air, allowing the lung to re-expand.

Chest Tube Insertion

For larger pneumothoraces, a chest tube may be inserted to continuously remove air from the pleural space until the lung fully re-expands.

Surgery

In cases of recurrent pneumothorax or when other treatments fail, surgery may be necessary. This can involve procedures like pleurodesis (adhering the lung to the chest wall) or bullectomy (removing air-filled sacs in the lungs).

What determines the choice of treatment for a collapsed lung? The size of the pneumothorax, the patient’s symptoms, and whether it’s a first-time occurrence or a recurrence are key factors in determining the most appropriate treatment approach.

Recovery and Prognosis: What to Expect After a Collapsed Lung

The recovery process from a collapsed lung varies depending on the severity of the condition and the treatment received. Understanding what to expect can help patients navigate their recovery more effectively.

Short-term Recovery

Immediately after treatment, patients may experience some discomfort or pain, especially if a chest tube was inserted. Pain medication is typically prescribed to manage these symptoms. Most patients start feeling better within a few days as the lung re-expands.

Long-term Recovery

Complete recovery from a collapsed lung can take several weeks to months. During this time, patients are advised to avoid activities that could stress the lungs, such as air travel or scuba diving.

Follow-up Care

Regular follow-up appointments are crucial to monitor lung function and ensure proper healing. Chest X-rays may be performed to confirm that the lung remains fully expanded.

Lifestyle Modifications

To prevent recurrence, patients may need to make certain lifestyle changes, such as quitting smoking or avoiding high-altitude activities.

How long does it take for a collapsed lung to fully heal? While initial recovery can occur within a few days to weeks, complete healing and return to normal activities may take up to 6-8 weeks, depending on the individual case.

Preventing Pneumothorax: Strategies to Reduce Your Risk

While not all cases of collapsed lung can be prevented, there are several strategies that can help reduce the risk of experiencing this condition.

• Quit smoking: This is one of the most effective ways to protect your lungs and reduce the risk of pneumothorax.
• Manage underlying lung conditions: Proper treatment of conditions like asthma and COPD can help prevent complications.
• Avoid sudden pressure changes: Be cautious during activities that involve rapid changes in air pressure, such as scuba diving.
• Protect yourself from chest injuries: Wear appropriate safety gear during contact sports or potentially dangerous activities.
• Regular check-ups: If you have a history of lung problems, regular medical check-ups can help detect issues early.

Can exercise help prevent pneumothorax? While exercise is generally beneficial for lung health, individuals with a history of pneumothorax should consult their doctor about safe exercise routines to avoid putting excessive stress on the lungs.

Understanding the nature of pneumothorax, its symptoms, causes, and treatment options is crucial for early detection and effective management. By recognizing the signs of a collapsed lung and seeking prompt medical attention, individuals can significantly improve their outcomes and reduce the risk of complications. Moreover, adopting preventive measures and maintaining overall lung health can play a vital role in minimizing the likelihood of experiencing this potentially serious condition.

What Does a Punctured Lung Feel Like?

Published on February 1, 2022

in Articles

If you are feeling an intense amount of pain when you breathe, you may be suffering a punctured lung. This condition is also called pneumothorax, from pneumo, which means related to the lungs, and thorax, which refers to the chest. Some people may refer to it as a collapsed lung.

Air can collect in the space between your lungs and the wall of your chest. When this happens, that extra air can cause pressure to push back on the outside of your lung. As a result, the lung can collapse.

A punctured lung, or collapsed lung, can be a complete collapse, or it can affect just one portion of the lung.

Symptoms of a Punctured Lung

The symptoms of a punctured lung mainly affect your breathing. However, lack of oxygen can cause other issues within the body as well. If you are suffering from punctured lung symptoms, you may be experiencing the following:

• Sudden, sharp pain in the chest, which increases or worsens when you take a deep breath, cough, or otherwise make a sudden move requiring air
• Shortness of breath – you may have to remind yourself to take deep breaths, you may feel winded doing things that are otherwise easy for you, and you may have trouble doing things that require a lot of air, such as singing
• Tightness in the chest
• Fatigue – you may find yourself getting tired much more quickly than usual
• Rapid heart rate – if you have something with a heart rate tracker, such as a smartwatch, it can help alert you to a rapid heart rate. The average heart rate for adults ranges from 60 to 100 beats per minute.
• Bluish tinge to the skin – this symptom is a result of a lack of oxygen.

Types of Punctured Lung

A punctured lung is categorized in three major ways, and the categorization helps explain potential causes. These causes are not definitive, but they can be helpful for you to understand the nature of your condition.

Traumatic Pneumothorax

This form of punctured lung occurs during direct trauma to the chest. Trauma can be anything from a gunshot or a broken rib sustained during a car accident. This is the form of a punctured lung that might inspire you to seek medical help from professionals who specialize in trauma care, such as Pro-Care Car Accident Doctors. There are also certain medical procedures that require pneumothorax for successful medical support. This deliberate form of pneumothorax also qualifies as traumatic pneumothorax.

Primary Spontaneous Pneumothorax

This form of punctured lung is the most difficult to determine a cause for. It can happen without any apparent precedent, and there is no specific cause to point to. As the name suggests, it can happen spontaneously. The most common way by which this form of punctured lung occurs is when a small air sac on the outside of the lung raptures, causing a leak into the cavity around the lung, between your lung and chest wall.

Secondary Spontaneous Pneumothorax

Like the above-mentioned primary spontaneous pneumothorax, this form of punctured lung can seem to appear out of nowhere. However, this type of punctured lung usually occurs as a side effect of a pre-existing lung disease. Some diseases that can result in collapsed or punctured lung symptoms can include lung cancer, asthma, or chronic obstructive pulmonary disease, known as COPD. It has also been identified as a concerning complication of COVID-19, occurring in as many as one in one hundred COVID-19 patients.

Tension Pneumothorax

This is one of the rarest but most life-threatening forms of lung collapse. Positive pressure is defined as pressure that is greater than the pressure in the environment surrounding it. In the case of pneumothorax, air gets trapped in the pleural cavity. The pleural cavity is the space between the two pleurae, or sections, of a lung.

Other Causes

Damaged lung tissue is much more likely to collapse than healthy tissue. Damage to the lungs can happen as a result of the diseases mentioned above, as well as cystic lung diseases, in which round air sacs form within the tissue. Lung damage is also a common result of smoking. Smoking also damages the small air sacs (also known as alveoli) in your lungs, making them more prone to collapse. Smoking is also the main cause of lung cancer cases, which frequently results in secondary spontaneous pneumothorax.

Some people experience diseases that require them to use mechanical tools to aid in their breathing. As a result, mechanical ventilation, such as those used frequently with COVID-19 patients, especially at the beginning of the pandemic, can cause pneumothorax. This occurs because ventilators may create imbalances within the lung and chest cavity which lead to air pressure collapsing the lung.

Risk Factors

The chances of sustaining a punctured lung may increase depending on certain factors about who you are, what your lifestyle is like, and your health history. There may also be some effect that comes from your genetic heritage. The risk factors increasing the likelihood of experiencing pneumothorax depend on the form of pneumothorax.

You may recall that primary spontaneous pneumothorax is the form of a punctured lung that can occur for seemingly no reason. You may be likely to experience this form of punctured lung if you are a smoker. People who are otherwise healthy but have a tall, thin body type are also more at risk for this kind of collapsed lung. Pregnancy is another risk. Although it can be treated in pregnant women, the chance of punctured lung symptoms recurring is anywhere between thirty to forty percent, with an increased likelihood during labor.

Marfan syndrome is a connective tissue disorder passed down through families, which can affect your heart, eyes, blood vessels, and skeleton. Pneumothorax is a common issue for people with this diagnosis.

Epidemiology

Young adults ranging in age from twenty to thirty are the most common sufferers of primary spontaneous pneumothorax. Men are more likely to experience punctured lungs of this nature, with the incidence rate in the United States being 7 per 100,00 men versus 1 per 100,00 women. Recurrence of symptoms for this form of punctured lung usually occurs within the first year after it is first diagnosed, with that recurrence rate at its highest during the first thirty days after diagnosis.

Secondary spontaneous pneumothorax, on the other hand, is more common among older adults, especially in the sixty to sixty-five age range. Men are still more likely to experience this form of the disorder, with an incidence rate of 6.3 per 100,000 men in the United States, compared to 2 per 100,000 women. Smokers are at risk more than any other population, with a risk one hundred and two times higher than non-smokers.

Traumatic pneumothorax, which is the form of punctured lung that occurs as a result of trauma to the chest area, occurs in one-fifth of victims of major trauma. The incidence rate for this form of punctured lung symptoms is 81 per 100,000 people of any gender, such that 20% of patients in a trauma care center may experience it.

Diagnosis

Pneumothorax is relatively easy for medical professionals to diagnose. Your doctor will most likely begin by using a stethoscope to listen to your breathing. If a punctured lung is the problem, then the doctor will hear breathing that is either greatly decreased or nonexistent. The doctor will then run a series of tests. The first among these tests will most likely be an x-ray of the chest to determine whether there is, in fact, air in the cavity between the lung or lungs and chest wall.

The doctor may also administer an arterial blood gas test, or ABG. This test measures the level of oxygen and carbon dioxide present in the blood. This test helps the doctor understand why you may have a hard time breathing. When your breathing is limited due to a punctured lung or a collapsed lung, there will be less oxygen and more carbon dioxide in your blood. This test is fairly quick, with results ready within fifteen or fewer minutes. Of course, this test alone is not enough to make a diagnosis, but it will give your doctor important information towards a complete and confident diagnosis.

In some cases, x-ray and arterial blood gas testing are not enough for your doctor to be completely sure that you are experiencing a punctured lung. In these cases, your doctor may order more detailed imaging, such as an ultrasound or a computerized tomography (CT) scan.

Treatment

The most important first step, and in fact the most important goal, is relieving any pressure on your lung. The pressure is what prevents your lung from fully expanding, thus causing the lack of oxygen reaching your blood. Your medical team may also administer treatment with the express purpose of reducing the likelihood of recurrence. Options for treatment are listed below.

Observation

Small pneumothoraces sometimes repair themselves. In these cases, your doctor may choose observation as the best course of treatment. This will consist of x-ray monitoring and returns to your pulmonary specialist, who will look for signs of the excess air being reabsorbed. It may be several weeks before your lungs can fully expand on their own again.

Aspiration

This form of treatment is most common when there is a large portion of collapsed lung. This method uses either a needle or a chest tube to remove the excess air from the cavity surrounding your lung.

In the case of needle aspiration, your doctor will insert a hollow needle with a small tube, or catheter, in between the ribs. When it is in the cavity creating the pressure on your lungs, the needle is removed. A syringe is attached to the catheter so that the air can be pulled out. The doctor may leave the catheter in so that the lung can fully expand and in order to avoid recurrence of the pneumothorax.

For chest tube insertion, a flexible tube is inserted into that air-filled cavity. It will be attached to a valve that continuously and carefully allows air to exit through the tube. As with a needle, this could take several hours, and your doctor will look for signs of recurrence.

Surgery

Sometimes, especially in the case of frequent recurrence, you may need surgery in order to address the way in which the air continues to leak into the cavity. This surgery is done by using a tiny camera to make a series of small incisions. The incisions are to help the doctor find the area of the lung that is causing the leak so that it can be closed off.

Less Invasive Treatment

There are some nonsurgical forms of treatment that may be appropriate, depending on the severity of your punctured lung. For example, your doctor may administer a substance that will inflame the lung tissue such that the tissues stick together and seal leaks.

Another nonsurgical option is to use a thin tube through your bronchial area (known as a bronchoscope). This tube will help the doctor look into your lungs and air passages. The tube can also be used to place a valve into your throat, which will help the lung expand.

Recovery

Like any injury, the amount of time it will take you to fully recover will depend on a number of varying factors. However, if you are otherwise healthy, treat the problem quickly, and follow your doctor’s prescribed aftercare plan, your lung will most likely be fully healed in six to eight weeks. To ensure that recovery is swift, make sure to take all medication as prescribed, participate in light activity with lots of rest, avoid smoking or sudden changes in air pressure such as during a flight, and practice breathing exercises.

Outlook

While some cases of punctured lung can be deadly if not treated right away, most people with this condition survive, especially if it is treated quickly. However, a major complication with pneumothorax is the increased likelihood of recurrence. Recurrence is especially likely if your punctured lung is the result of trauma to the chest, such as in the case of a car accident or if you are a smoker.

References

• Pneumothorax – Symptoms and Causes
• Health Effects of Cigarette Smoking
• Pneumothorax
• What is tension pneumothorax
• Recurrent spontaneous pneumothorax during pregnancy
• Marfan Syndrome
• The incidence and predictors of pneumothorax among trauma patients in Saudi Arabia

More Articles

Welcome Austin Chiropractor, Dr. Bryan Woods!

We’re excited to welcome a new provider to the Pro-Care family! Dr. Bryan Woods, DC, joins our Central Austin clinic. He’s been practicing chiropractic in Austin for several years. Get…

Continue Reading

Avoid These Activities If You Have Cervical Spinal Stenosis

Cervical spinal stenosis is a condition characterized by the narrowing of the spinal canal in the neck, which can lead to compression of the spinal cord and nerves. To effectively…

Continue Reading

Headache After Chiropractic Adjustment: Is It Normal?

A chiropractic adjustment, also known as spinal manipulation, is a non-invasive technique that involves applying controlled force to a joint to restore its function and alleviate pain. During a chiropractic…

Continue Reading

How Often Should You Do Spinal Decompression Therapy?

Spinal decompression therapy is a non-invasive treatment that can help alleviate your back pain and treat a wide variety of spinal conditions. Medication and surgery are not always necessary or…

Continue Reading

Pneumothorax (Collapsed Lung): Symptoms, Causes, and More

A collapsed lung is the medical term for when air escapes outside of the lungs into the chest. The pressure causes the lung to be unable to expand. This is also called pneumothorax.

Pneumothorax is the medical term for a collapsed lung. It occurs when air enters the space around your lungs (the pleural space). This can happen when an open injury in your lung tissue causes air to leak into the pleural space. The resulting increased pressure on the outside of your lung causes it to collapse.

Pneumothorax can be traumatic or nontraumatic.

Traumatic pneumothorax results from an injury, like a blow to the chest. Nontraumatic pneumothorax can happen if you have lung disease, like chronic obstructive pulmonary disease (COPD), but it can also happen for no apparent reason in people without lung disease.

The long-term impact of pneumothorax can vary. If only a small amount of air is trapped in the pleural space, there may be no further complications. If the volume of air is larger or it affects the heart, it can be life-threatening.

If pneumothorax results from trauma, the symptoms often appear at the time of the injury or shortly after. Symptoms of spontaneous pneumothorax might appear when a person is at rest. A sudden attack of chest pain is often the first symptom.

Symptoms may include:

• a sudden, sharp, stabbing pain in the chest
• rapid breathing or shortness of breath (dyspnea)
• turning blue, known as cyanosis
• a rapid heart rate
• low blood pressure
• lung expansion on one side
• a hollow sound if you tap on the chest
• an enlarged jugular vein
• anxiety
• fatigue

There are different ways of categorizing pneumothorax, according to their causes or their impact.

One way of differentiating them is as follows:

• traumatic pneumothorax
• nontraumatic pneumothorax
  • primary spontaneous
  • secondary spontaneous

Other subtypes with either traumatic or nontraumatic causes are:

• simple, when it does not affect the position of other structures
• tension, which affects the position of other structures, like the heart
• open, when air moves in and out of an open wound in the chest

Traumatic pneumothorax

Traumatic pneumothorax occurs after some type of trauma or injury has happened to the chest or lung wall. It can be a minor or significant injury. The trauma can damage chest structures and cause air to leak into the pleural space.

Here are some types of injuries that can cause traumatic pneumothorax:

• trauma to the chest from a motor vehicle accident
• broken ribs
• a blow to the chest during a contact sport, like football tackle
• a stab or bullet wound to the chest
• accidental damage during a medical procedure like a central line placement, ventilator use, lung biopsies, or CPR
• diving, flying, or being at high altitude due to air pressure changes

Quick treatment of pneumothorax due to chest trauma is critical as it can lead to fatal complications like cardiac arrest, respiratory failure, shock, and death.

Nontraumatic pneumothorax

This type of pneumothorax is called spontaneous, as it does not result from trauma.

When primary spontaneous pneumothorax happens, there’s no clear reason why it occurs. It’s more likely to happen:

• in people who smoke
• during pregnancy
• in people with Marfan syndrome
• in those with a family history of pneumothorax
• in an otherwise healthy person with a tall, thin body

Secondary spontaneous pneumothorax can happen if a person has:

• a form of COPD, including emphysema and chronic bronchitis
• acute or chronic infection, like tuberculosis or pneumonia
• lung cancer
• cystic fibrosis
• asthma
• severe acute respiratory distress syndrome (ARDS)
• idiopathic pulmonary fibrosis
• collagen vascular disease

Inhaling drugs like cocaine or marijuana can also trigger it.

Tension pneumothorax

Tension pneumothorax is not a classification of pneumothorax but a term that reflects the severity of pneumothorax. You may experience it if you have:

• a blow to the chest
• a penetrating injury
• changes in pressure when diving, flying, or mountaineering
• a spontaneous pneumothorax progressing to a tension type
• some medical procedures

The risk factors are different for a traumatic and spontaneous pneumothorax.

Risk factors for a traumatic pneumothorax include:

• contact sports, like football or hockey
• employment where there’s a risk of falls or other types of injury
• having a medical procedure that involves the chest or lung area
• ongoing assisted respiratory care

The people at highest risk of a nontraumatic pneumothorax include those who:

• have a history of smoking
• have an existing lung condition, like asthma or COPD
• have a family history of pneumothorax, which may indicate genetic factors
• have tall, slim bodies, as this can affect pressure at the top of the lung
• have inflammation in the small airways

Pneumothorax can lead to a number of complications, some of which can be life-threatening.

They include:

• respiratory failure or inability to breathe
• pulmonary edema following treatment for pneumothorax
• pneumohemothorax, when blood enters the chest cavity
• pneumopericardium, when air enters the cavity around the heart
• pneumoperitoneum, when are enters the space around the abdomen
• bronchopulmonary fistula, when a passageway opens between the lungs and the space around them
• heart attack

Tension pneumothorax can quickly progress to:

• an inability to breathe
• cardiovascular collapse
• death

It’s essential to seek emergency medical help as soon as symptoms arise.

Treatment aims to relieve pressure on the lung and allow it to re-expand.

The options will depend on:

• how severe the condition is
• whether the chest cavity is continuing to expand
• the cause
• whether it’s happened before or has been going on for some time

If you have tension pneumothorax or pneumothorax due to an injury, this is a life-threatening emergency. You’ll need immediate medical care and possibly surgery.

Here are some of the treatment strategies:

Observation

If pneumothorax results from a small injury, it may heal without treatment within a few days. Check with a doctor before flying or diving after pneumothorax.

If you’re having trouble breathing, you may need oxygen. Using oxygen can also help speed up the rate at which the lungs reabsorb air from the cavity.

Draining excess air

If the damage is significant or symptoms are severe, a surgeon may need to remove the air or carry out surgery.

Needle aspiration and chest tube insertion are two procedures designed to remove excess air from the pleural space in the chest. These can be done at the bedside without requiring general anesthesia.

In needle aspiration, the doctor inserts a needle into the cavity and extracts the air using a syringe.

For a chest tube insertion, the doctor will insert a hollowed tube between your ribs. This allows air to drain and the lung to reinflate. The tube may remain in place for 2 to 5 days or longer.

Surgery

The doctor may need to carry out a more invasive procedure to see what’s happening in your lungs, like a thoracotomy or thoracoscopy.

During a thoracotomy, your surgeon will create an incision in the pleural space to help them see the problem. During a thoracoscopy, also known as video-assisted thoracoscopic surgery (VATS), the doctor inserts a tiny camera through the chest wall to examine the lung.

If you’ve had repeated episodes of pneumothorax, you may need a small operation to repair any weak areas in the lung where the air is getting through. The doctor may also carry out pleurodesis, in which they stick the lung to the inside of the chest wall.

Other surgical options include:

• sewing blisters closed
• closing air leaks
• or removing the collapsed portion of your lung, which is called a lobectomy

These interventions can reduce the risk of pneumothorax happening again.

In many cases, a person with pneumothorax will need emergency medical treatment, and emergency doctors will carry out the evaluation and diagnosis.

A doctor will look for signs of air in the space around the lungs.

They’ll ask about:

• symptoms
• personal and family medical history
• recent activities
• any previous cases of pneumothorax

They may also carry out imaging tests, like:

• an X-ray
• a CT scan
• a thoracic ultrasound

Your long-term outlook depends on the size of the pneumothorax, the cause, and any treatment you receive.

Most cases of primary spontaneous pneumothorax resolve with observation or minimal treatment. It’s rarely life-threatening. But there’s a 30 percent chance that this type will recur within 5 years, and the risk of recurrence increases each time it happens.

It may take longer to recover if:

• you have a large pneumothorax
• you have a secondary spontaneous pneumothorax
• you have an underlying lung condition
• pneumothorax results from an injury
• it’s not your first experience of pneumothorax

In around 10% of cases, secondary spontaneous pneumothorax is fatal. The risk is higher if you have HIV or COPD. The risk of this type recurring within 5 years is around 43 percent, and the risk increases each time it happens.

Knowing your risk of developing pneumothorax and seeking help as soon as symptoms occur can help prevent severe complications.

Pneumothorax is a condition where air collects between the lungs and the chest cavity. In some cases, it’ll go away without treatment. In others, it can be life-threatening. This will depend on the size and cause of the problem.

There are different types of pneumothorax. Traumatic pneumothorax can happen if someone has an injury to the chest wall or lungs. Nontraumatic pneumothorax can affect people with COPD and other lung diseases, but it can also affect people without lung disease.

Treatment aims to remove the air and re-expand the lungs. In some cases, a surgeon may need to repair the lungs. Pneumothorax can be a life-threatening emergency. Anyone who experiences symptoms, like a sharp, stabbing pain in the chest, should seek immediate medical help.

Lung cancer metastases

How often does lung cancer metastasize? In which organs are metastases most often found? Are there effective treatments? What are the predictions? Is remission possible?

The ability to metastasize is one of the key features of malignant tumors. Cancer cells can break away from the primary, “maternal” tumor, spread throughout the body with blood or lymph flow and give rise to secondary foci in other organs. Actually, this process is called metastasis.

Metastases are always named after the primary tumor. For example, if lung cancer has metastasized to the bone, then it is called lung cancer with bone metastases, but not bone cancer.

How often does lung cancer metastasize?

Fairly common. According to statistics, 40% of patients who have recently been diagnosed with lung cancer have metastases. With this picture, the fourth stage of a malignant tumor is diagnosed. Naturally, the prognosis in this case is significantly worse than in the early stages, when there are no metastases.

The reason for such a frequent late diagnosis is that in the early stages lung cancer does not manifest itself, or there are symptoms, but they resemble another disease, for example, chronic bronchitis or COPD. Many smokers do not pay attention to constant coughing and shortness of breath, taking them for granted – but these may be the very “first bells”.

Small cell and non-small cell lung cancer metastases: is there a difference?

The rarer small cell type of lung cancer differs from the more common non-small cell type in higher aggressiveness. Usually, it grows faster into neighboring organs and metastasizes earlier. As a rule, patients with small cell cancer experience symptoms such as increased fatigue, weight loss, and bone pain more quickly.

In what organs are most often found lung cancer metastases?

Metastases in the lymph nodes

Most often, malignant lung tumors metastasize to the lymph nodes, bones, brain, liver and adrenal glands.

If tumor cells spread to regional lymph nodes located in the chest close to the lungs, such cancer is not yet considered metastatic. It usually does not cause any symptoms.

Having overcome the regional lymph nodes, cancer cells continue to migrate with the lymph flow, and can penetrate into the lymph nodes located under the skin. Affected subcutaneous lymph nodes increase, become painful. They can be felt.

Methods of treatment. If the tumor has spread to nearby lymph nodes, they can be surgically removed. Apply chemotherapy, radiation therapy.

Bone metastases

Bone metastases occur in approximately 30-40% of patients with stage IV lung cancer. Most often, cancer cells spread to the vertebrae, pelvis, humerus, and femur.

The most common symptom of bone metastases is bone pain. At first, there is a feeling of discomfort, muscle tension, gradually it increases, the pain becomes more and more severe.

With the progression of the process, pathological fractures can occur, the bone breaks from minor trauma or even from normal everyday stress. Calcium is washed out of the bone tissue into the blood, because of this, appetite decreases, weakness in the muscles occurs.

Metastases in the vertebrae are the most dangerous, as they can cause compression of the spinal cord. Terrible symptoms of this condition: numbness, weakness in the muscles of the legs, urinary and stool incontinence.

Bone metastases in lung cancer are detected using CT, MRI, PET.

Methods of treatment. It is necessary to slow down the growth of metastases, prevent pathological fractures and save the patient from pain. To do this, use radiation therapy, painkillers, drugs that prevent the destruction of bone tissue. Sometimes surgery is indicated to stabilize the bones.

Brain metastases

Lung cancer is one of the most common malignant tumors that metastasize to the brain. At stage IV, brain metastases are found in about 40% of cases.

One third of these patients do not experience symptoms. Two-thirds experience manifestations associated with the destruction of brain tissue by metastases, inflammation and edema.

Worried about headaches and various neurological symptoms: convulsions, speech disorders, impaired coordination of movements and a sense of balance, blurred vision, memory, weakness in half of the body, as in a stroke, personality changes, chronic fatigue.

MRI and computed tomography are used to diagnose lung cancer metastases in the brain.

Methods of treatment. Provide palliative care to manage symptoms. To combat seizures and headaches, painkillers and anticonvulsants are used. Swelling and inflammation are removed with the help of steroid drugs.

Radiation therapy helps reduce the risk of brain metastases, and if they have already appeared, slow their growth and improve the patient’s condition. With single small foci, you can use the “gamma knife”.

Liver metastases

Most often, liver metastases from lung cancer are not accompanied by any symptoms. They are discovered during the examination. Some patients are concerned about the loss of appetite, nausea, pain under the right rib. If there are many metastases, and they severely impair liver function, jaundice develops.

Detect liver metastases during ultrasound, CT or positron emission tomography (PET).

Methods of treatment. If one small metastasis is found in the liver (which is rare), it can be removed surgically. In most cases, they are treated with chemotherapy drugs. In some cases, resort to the help of interventional surgery:

• Radiofrequency ablation is a procedure during which a thin metal needle is inserted into the tumor and a high frequency current is applied to it. It burns cancer cells.
• Intra-arterial chemotherapy – when the chemotherapy drug is not injected into the systemic circulation, but directly into the vessel that feeds the tumor.
• Chemoembolization is a procedure during which microspheres-emboli and a chemotherapy drug are injected into the vessel that feeds the tumor. Emboli block the lumen of the arteries, depriving cancer cells of nutrients and oxygen, and the chemotherapy drug destroys them.

Metastases in the adrenal glands

The adrenal glands are a small paired gland. They are located near the kidneys and produce some hormones, in particular, glucocorticosteroids and “stress hormones”. Metastases in them rarely give symptoms, most often detected during the examination.

Methods of treatment. If one small metastasis is found in the adrenal glands, it can be surgically removed. Often this helps to prolong the life of the patient.

How to treat lung cancer metastases?

Single small metastases can be removed. Unfortunately, most often lung cancer metastases are multiple, located in different organs, and surgical treatment is impossible.

Targeted therapy for lung cancer metastases

Molecular genetic testing helps to prescribe the most correct and effective treatment. If there are some mutations in cancer cells, targeted drugs help to cope with them:

• If there is a mutation in the ALK gene: crizotinib, ceritinib, alectinib, brigatinib.
• With a mutation in the EGFR gene: erlotinib, gefitinib, afatinib.
• With a mutation in the ROS1 gene: crizotinib.
• With a mutation in the BRAF gene: dabrafenib, trametinib.

Immunotherapy for lung cancer metastases

Immunotherapy helps the patient’s immune system recognize and attack tumor cells. If the tumor cells contain large amounts of a protein called PD-L1, treatment with certain immunotherapy drugs, such as pembrolizumab, may be effective.

Chemotherapy for metastatic lung cancer

Chemotherapy is used in most cases of stage IV lung cancer with metastases. Depending on the characteristics of the tumor and the condition of the patient, the doctor may prescribe therapy with one or a combination of drugs. Chemotherapy is often combined with targeted drugs such as pembrolizumab, bevacizumab, necitumumab.

In most cases, treatment for metastases is palliative. It cannot cure, but it can relieve pain and other symptoms, prolong life.

How long do these patients live?

Metastatic cancer is difficult to treat:

• Five-year survival (the percentage of patients who are still alive after 5 years from diagnosis) is 1-2%.
• Median survival (time after which half of the patients died, the other half remained alive) – 6-12 months (without treatment – 2-4 months).

However, such negative statistics are not a reason to give up.

Some patients (albeit a few out of a hundred) still remain alive for a very long time, many years. No one knows in advance which of those who have just been diagnosed with stage IV lung cancer will fall into the number of these survivors.

In addition, science does not stand still. Now doctors and scientists have high hopes for immunotherapy and targeted drugs. Treatment methods are improving, which means that the chances of defeating cancer are increasing.

What are lung metastases?

Lung metastases are foci that have appeared in the lung tissue as a result of metastasis, while the main, primary, tumor is located in another organ. Such lung cancer is called secondary or metastatic. Statistics show that it occurs in about 30-35% of cancer patients. Tumors from many organs metastasize to the lungs.

What are lung metastases?

Metastases in the lungs, depending on the form, are focal (nodes with more or less even edges, less aggressive option), infiltrative (when the tumor seems to “spread” over the lung tissue – such metastases are more aggressive) and mixed.

Depending on the number, solitary (one focus), single and multiple metastases are distinguished. They also differ in density (this can be estimated from x-rays), depending on where the tumor metastasized to the lungs from and what tissue it consists of. If one lung is affected, they speak of unilateral metastases, if both lungs are affected, they speak of bilateral. Depending on the size, the foci are divided into small and large.

How to diagnose lung metastases?

It is difficult to diagnose lung metastases by symptoms. Sometimes there are no symptoms at all, if there is only one focus, it is small and has even contours. Infiltrative metastases begin to appear earlier and brighter. Symptoms are non-specific, they occur in primary lung cancer and in other diseases. Worried about cough, shortness of breath, chest pain, sputum with blood, weakness, weight loss.

The following methods help diagnose lung metastases:

• Chest x-ray may show lesions in the lungs, but only if the diameter of the latter exceeds 1 cm.
• Computed tomography is a more informative diagnostic method that allows you to detect lesions smaller than 5 mm.
• Bronchoscopy is a procedure during which a bronchoscope is inserted into the bronchi – a special endoscopic instrument with a miniature video camera and a light source.
• If a suspicious mass is found during the examination, the doctor may perform a biopsy of it.
• A lung biopsy is an invasive examination during which a needle is inserted into the lung tissue through the chest wall and some tissue is taken from the lesion.

Treatment of lung metastases

Chemotherapy is the main treatment for lung metastases. If hormone-dependent breast cancer has metastasized, hormonal therapy is performed. Radiation therapy can be used for a single metastasis, but it helps much less than for primary lung tumors.

Surgical treatments are rarely used, although modern doctors operate on lung metastases more and more often. In order for surgical intervention to be possible, certain conditions must be met:

• One or no more than three small metastases in the lungs.
• No primary tumor or its recurrence.
• No metastases elsewhere in the body.
• 12 months or more passed from the moment of treatment of the main tumor to the appearance of metastasis.
• Within six months after a metastasis is detected, no other metastases should appear.
• The patient has no contraindications to surgical treatment due to concomitant health problems.

When metastases stop responding to chemotherapeutic agents, grow strongly and disrupt lung function, respiratory failure occurs. The patient requires oxygen therapy, and in more severe cases, artificial lung ventilation.

Prognosis for lung metastases

Prognosis for sustained remission in any metastatic cancer is poor. A very small percentage of patients recover, but in most cases such cancer cannot be cured. But a doctor can prolong the patient’s life and save him from painful symptoms. You can always help.

How is the development of metastases stopped?

First of all, early diagnosis plays a role. The ideal option is if the cancer is detected at an early stage, when there is no question not only of metastases, but also of germination into neighboring tissues. Unfortunately, this is a difficult task, because in the early stages, many oncological diseases do not manifest themselves in any way, a person does not suspect that he is sick.

Screening helps in the early detection of cancer of the lung and other organs. All high-risk people, especially long-term smokers, should be screened regularly. In Russia, this is traditionally fluorography, but data from scientific studies show that CT is the most effective.

Lung metastases may also occur after remission. Therefore, regular chest x-rays are included in the follow-up program after successful treatment. If a focus is found on radiographs, computed tomography is performed.

Nuclear weapons. Actions in case of danger of radioactive contamination. – Recommendations to the public

Nuclear weapons are the most powerful in terms of their damaging properties. Depending on the nature of the targets, high-altitude, air, ground, underground, surface and underwater nuclear explosions can be used

The damaging factors of a nuclear explosion are: shock wave, light radiation, penetrating radiation, radioactive contamination.

The shock wave is a powerful damaging factor in a nuclear explosion. It causes damage to people and animals of various nature and severity, destroys buildings and structures. With the distance from the center (epicenter) of the explosion, its destructive power weakens. From the impact of the shock wave, shelters protect, to a large extent weaken its impact by shelters. At a considerable distance from the site of the explosion, terrain folds and local objects can serve as protection.

Light radiation is a stream of radiant energy emanating from the luminous area of ​​a nuclear explosion and includes visible, ultraviolet and infrared rays. It causes skin burns and eye damage in unprotected people and animals, massive fires.

Shelters and shelters, as well as completely or partially – objects made of non-combustible materials, terrain folds protect from exposure to light radiation.

Penetrating radiation is a stream of gamma rays and neutrons emitted into the environment from a nuclear explosion zone within a few seconds. In humans and animals, penetrating radiation causes radiation sickness of varying severity. Shelters provide protection from penetrating radiation. Weaken the impact of penetrating radiation on a person shelters, terrain folds and local objects.

Radioactive contamination is the result of the fallout of radioactive substances from the cloud of a nuclear explosion (radioactive trace). It can be moderate, severe and dangerous. Radioactive contamination, like penetrating radiation, causes radiation sickness. Shelters, anti-radiation shelters serve as protection against radioactive contamination, and from the ingress of radioactive substances on the surface of the body and into the body, in addition, personal protective equipment.

The area where a nuclear explosion caused mass destruction of people and animals, destruction of buildings and structures, fires and radioactive contamination, is called the focus of nuclear damage. Its size depends on the power and type of nuclear explosion, on the terrain, the nature of buildings and a number of other factors.

Means and methods of protecting the population

Knowing the means and methods of protecting against weapons of mass destruction is one of the most important conditions for saving your life and the lives of many people. In a modern nuclear missile war, various methods will be used to protect the population from weapons of mass destruction. The main ones are: the shelter of the population in collective protective equipment – protective structures, the evacuation of the population from large cities to the suburban area, the use of personal protective equipment. In addition, everyone should be able to use the protective properties of the terrain and local items.

Collective protective equipment

You should know where the nearest shelters and shelters are located in your place of work and residence. Protective structures of civil defense are designed to protect people from modern weapons. They are divided into shelters and anti-radiation shelters.

Shelters

Shelters provide the most reliable protection for people from shock waves, light radiation, penetrating radiation and radioactive contamination during nuclear explosions, from poisonous substances and bacterial agents, as well as from high temperatures and harmful gases in fire zones. You can stay in shelters for a long time. Shelters are equipped in the recessed part of buildings or located outside buildings. In addition, existing buried structures (basements, tunnels), underground workings (mines, mines) can be adapted for shelters. The shelter consists of the main premises, lock chambers (tambours), a filter-ventilation chamber, a sanitary unit; has two entrances. Entrances are equipped with protective and hermetic doors. The built-in shelter, in addition, must have an emergency exit. Shelters use filter-ventilation units with electric or manual drive. With the help of such installations, the outside air is cleaned of radioactive, poisonous substances and bacterial agents and is supplied to the shelters. The filter-ventilation unit can operate in two modes – in clean ventilation mode (the air is cleaned only from dust in anti-dust filters) and filter ventilation mode (the air is cleaned of poisonous substances, bacterial agents and radioactive dust in absorber filters). Water supply and sewerage systems are equipped in the shelter , heating and lighting, radio and telephone are installed. In the main room there should be benches for sitting and bunk beds for lying. Each shelter must be equipped with a set of means for conducting reconnaissance in the contaminated area, equipment, including emergency equipment, and emergency lighting equipment. It is necessary to constantly monitor the health of the shelter equipment.

Radiation shelters

You must be able to equip or build a shelter. Anti-radiation shelters protect people from radioactive contamination and light radiation and weaken the impact of the shock wave and penetrating radiation of a nuclear explosion. They are usually equipped in the basement or ground floors of buildings and structures. It should be remembered that various buildings and structures weaken penetrating radiation in different ways: the premises of the first floor of wooden buildings weaken it by 2-3 times, the premises of the first floor of stone buildings by 10 times, the premises of the upper floors (with the exception of the topmost) of multi-storey buildings – 50 times, the middle part of the basement of a multi-storey stone building – 500-1000 times. The most suitable for anti-radiation shelters are the interiors of stone buildings with solid walls and a small area of ​​openings.

If there is a threat of radioactive contamination, these openings are sealed with improvised materials: bags with soil, bricks, etc. If necessary, separate anti-radiation shelters are built. When choosing a place to build a shelter, the terrain, the nature of the soil and the level of groundwater are taken into account. During the construction of shelters, industrial (prefabricated concrete elements, bricks, fittings, pipes, rolled metal) or local (wood, stone, adobe, brushwood, reeds) building materials are used. In winter, frozen soil, ice and snow can be used. For example, a compacted layer of snow 60 cm thick attenuates radiation by a factor of 2. Construction begins with tracing the shelter on the ground. Then the sod is removed and a trench is torn off 180-200 cm deep, 100 cm wide along the bottom with a single-row or 160 cm with a two-row arrangement of places. The length of the shelter for 10-15 people should be approximately 7-9m (with a single-row arrangement of places). In soft soils, clothes of coolness are arranged. Entrances should be at an angle of 90° to the longitudinal axis of the shelter. At the bottom, a drainage groove is torn off, a floor is laid and benches are placed at the rate of 0.5 m per person and bunk beds for lying. A drainage well (up to 50 cm deep) is torn off at the entrance, and a ventilation duct or a simple fan is installed at the opposite end from the entrance. After laying the floor, a layer of soil with a thickness of at least 60 cm is poured on it; the soil is covered with sod, and a ditch is cut off around the shelter to drain rainwater. The entrance is equipped with two curtains made of dense material; a waste container is installed between them in a special niche. The supply of water is stored in tanks.

The construction of an anti-radiation shelter, depending on its design, must be completed in the shortest possible time.

If there are underground workings or natural underground cavities in the area, they can also be adapted for radiation shelters.

Basic Shelter

You must be able to build basic Shelter. The most accessible means of protection against modern weapons are the simplest shelters.

They weaken the impact of the shock wave and radioactive radiation, protect against light radiation and debris from collapsing buildings, protect against direct contact with clothing and skin of radioactive, toxic substances and bacterial agents. The simplest shelter is a gap, which is usually torn off with a depth of 180-200 cm, a width of 100-120 cm on top and 80 cm along the bottom, with an entrance at an angle of 90° to its longitudinal axis. The length of the gap is determined at the rate of 0.5 m per one sheltered person. Subsequently, the protective properties of the open gap are enhanced by arranging steepness clothes, floors with soil sprinkling and a protective door. Such a cover is called a covered gap. The tracing, excerpt and arrangement of the sharpness of the crack are carried out in the same way as it is done during the construction of an anti-radiation shelter. The entrance to the slot can be made in the form of a vertical manhole with a hatch covered from the outside with a shield. If there is time and materials, the protective properties of the closed gap can be gradually brought up to the level of the protective properties of the anti-radiation shelter. In areas with dense buildings, there is not always enough space for the construction of slots. Therefore, it is possible to adapt basements, tunnels and other recessed rooms for shelters. When equipping a basement, first of all, it is necessary to strengthen the ceiling with the help of racks and girders so that it can withstand the load from the debris of the building in case of its destruction; then make an emergency exit in the form of a covered trench with access to the surface at a distance equal to the height of the building; close the openings in the outer and inner walls, leaving only the entrances and openings for ventilation.

Terrain defenses

You must know and be able to use terrain defenses. The protective properties of the terrain depend on its relief, on the shape of local objects and their location relative to the explosion. The best protection is provided by narrow, deep and winding ravines, quarries and especially underground workings. Hills with steep slopes, embankments, pits, low stone fences and other shelters of this type are also good protection against the damaging factors of a nuclear explosion. Small recesses, hollows, ditches have some protective properties. Forest areas weaken the effect of all damaging factors of a nuclear explosion. They reduce the force of impact of a shock wave, penetrating radiation, reduce radioactive contamination, and weaken the effect of light radiation. However, it should be remembered that light radiation causes a fire in the forest. The young deciduous forest is the least susceptible to fire, and it should be used primarily for protection purposes. Since a strong shock wave breaks and destroys trees, it is best to be located in the forest in clearings and clearings covered with shrubs. In the absence of clearings (cuttings) in the forest, one should hide in the depths of the forest at a distance of at least 30-50 m from roads and clearings and 150-200 m from the edges of the forest.

The simplest ways to protect yourself

Remember the simplest ways to protect yourself. If at the time of a nuclear explosion you find yourself outside a shelter or shelter, you must quickly lie face down on the ground, using low stone fences, ditches, ditches, pits, stumps, embankments of highways and railways, forest plantations for protection. You can not take cover near the walls of buildings and structures – they can collapse. When flashing, close your eyes – this can protect them from damage by light radiation. To avoid burns, open areas of the body must be covered with some kind of cloth. When the shock wave passes, you need to get up and put on personal protective equipment. If they are not there, you should cover your mouth and nose with any bandage (shawl, scarf, etc.) and dust off your clothes.

Child protection and adult responsibilities

Children must be supervised at all times when there is a threat of attack. First of all, it is necessary to provide children with respiratory protection equipment. It is advisable to issue gas masks and respirators to schoolchildren at school. In addition to a gas mask and a respirator, each child must be provided both at home and in a children’s institution, school with an anti-dust fabric mask or a cotton-gauze bandage. Then children’s clothes and shoes are prepared to protect against radioactive dust.

Adults should check that protective equipment is working and show children how to use it. It is desirable that children practice putting on and taking off a gas mask, a respirator. Parents, staff of schools and children’s institutions clarify the procedure for going to shelters or shelters, places for children to be placed in them. Parents, and especially the staff of nurseries, children’s homes, maternity hospitals, should be well aware of the device of the nursery’s protective camera and the rules for using it. During the child’s stay in the cell, the temperature in it, as a rule, is 3-4 ° higher than the outside temperature, which should be taken into account when choosing clothes for the baby. To avoid overheating, it is recommended to protect the camera from direct sunlight.

In case of rain, cover the camera with some kind of waterproof cloth, but not too tightly.

Protection of the apartment (house) from the penetration of radioactive dust and aerosols

To increase the tightness of the room, seal all cracks in the doors and door frames, putty the cracks in the window frames and openings, close the vents, chimneys and other openings. In this case, it is advisable to use a sticky polymer tape. Slots in the places where the door adjoins the door frame can be sealed with gaskets made of rubber, foam rubber or other similar material

A sealed room without special air purification devices must be ventilated. To do this, you will have to open a door or window curtained with fabric. Such preparation of an apartment (house) is necessary because in the event of radioactive contamination, after leaving the shelter or anti-radiation shelter, it will be necessary to spend some time indoors before receiving the appropriate order from the civil defense authorities.

Blackout

After receiving an order for blackout, immediately cover all light openings in residential, administrative, industrial, commercial and other buildings with light protection devices: curtains, shutters or shields. In stairwells, lobbies and other places where it is difficult to do without lighting, you can use special lamps or lighting fixtures. In a room with normal lighting, external doors must be equipped with vestibules or curtained with curtains. The quality of the blackout of an apartment, house, industrial, administrative building, etc. must be checked by examining the windows and doors of the building from the street. When leaving an apartment, house or other premises, do not forget to turn off the light.

Protecting food and water from contamination

The main way to protect food and water from contamination is to isolate them from the environment. Therefore, the sealing of apartments, houses, pantries and storage already creates a certain degree of protection. Wrap the products in parchment, cellophane and put them in protective bags made of rubberized fabric or plastic film, in wooden or plywood boxes lined with thick paper inside, in barrels with tight-fitting lids. Refrigerators and various household utensils can also be used for these purposes. To protect water and liquid products, use dishes with well-fitting lids, vessels with ground stoppers – thermoses, jars, bottles. Fresh vegetables and potatoes are safer to store in the basement, cellar, underground. To protect open wells, an clay castle up to 50 cm thick and up to 1.5–2 m wide is made around the upper part of the log house, and a layer of crushed stone, gravel or pebbles up to 10 cm thick is poured on it. close with a tight lid.

Evacuation procedure

First of all, take personal protective equipment with you, from things – only the most necessary things (clothing, shoes, underwear and bed linen, toiletries). You should also have a small supply of food, preferably those that do not spoil and do not require cooking, as well as the most necessary medicines. Put things and products in a backpack or bag, convenient for carrying. Be sure to wear shoes that are comfortable for walking. Attach a tag to each suitcase, backpack or bag with your name, address of permanent residence and place of evacuation. You must have a passport, military ID, documents on education and specialty, work book, birth certificates of children. When everything is ready, turn off electrical appliances, lights, close the apartment. By the set time, you should arrive with things at the assembly evacuation point. There you will be registered and the transport or convoy will be indicated, in which you will follow to your destination. Along the way, discipline and organization must be observed. When evacuating in vehicles, follow all the instructions of the heads of trains, convoys, ship captains. Do not get off at stops. Following on foot, keep your place in the column, follow all commands and signals, and help those who are lagging behind.

You will be given your place of residence at the accommodation point in the countryside. The supply of essential food and industrial goods, as well as public utilities and medical services will be organized.

Actions while in and out of the containment

While in the containment, follow all the instructions of its commandant (commander of the unit for maintenance of shelters). Follow the established order. Keep your personal protective equipment ready. It is forbidden to make noise in protective structures, to walk unnecessarily, to smoke, to light matches, candles, kerosene lamps without permission, to throw food waste in unspecified places. Monitor the behavior of children in protective structures. If it becomes necessary to wear respiratory protection, check that children are wearing it correctly. Control the amount of time children spend in protective equipment. If the defensive structure is damaged, remain calm and do not create a panic; remember that civil defense formations will come to the rescue. When necessary, join in the work to repair damage or provide access to the surface. You need to leave the lesion in the direction of the least damage or surviving buildings, structures, forest plantations, etc. Remember that surrounding objects can be contaminated with radioactive substances, so try not to touch them. Do not approach damaged buildings and structures – they may collapse. Provide assistance to the victims. Help bring out

from the lesion of the elderly, women, children.

Rescuing people from rubble and damaged protective structures

As a rule, military units and civil defense formations are engaged in rescuing people who find themselves in rubble, damaged shelters and shelters. But all able-bodied citizens can be involved in this work. During rescue work, first of all, it is necessary to locate the victims, for which it is necessary to carefully examine the rubble, damaged and destroyed buildings, road structures and other places where people may be. Particular attention should be paid to basements, staircases, near-wall and corner spaces of floors.

Do not forget about safety measures! Do not walk unnecessarily through rubble, do not enter damaged buildings if the walls threaten to collapse, do not touch bare wires, etc. To free people buried close to the surface, the blockage must be dismantled from above manually. If the victims are in the depths of the blockage, then a passage should be made on the side of the blockage, using voids and cracks for this, or the blockage should be disassembled from above using the technique. When dismantling the blockage, proceed carefully so as not to cause additional damage to people who are under it. First of all, try to free the head and chest of the victim. After extraction from the rubble, the victim must be given first aid. Having found a damaged protective structure, try to establish contact with the people in it, determine their condition and the degree of damage to the filter-ventilation equipment. If there is no connection, first of all it is necessary to supply air to the structure. To do this, you need to clear the blocked air intakes or, if they turn out to be faulty, punch a hole in the wall. The location of the head or hatch of the emergency exit, as well as the entrance to the protective structure, is determined by copying from the location plan of the structure or by questioning (with the help of signals) people who have taken refuge in the structure. For digging the entrance or emergency exit, equipment is used – bulldozers, excavators.

If there is no emergency exit (or it is under a high blockage), and the entrances are heavily blocked, you should break through the walls or, in extreme cases, the ceiling of the structure. This is done in the place where the blockage has the smallest height. To punch holes in walls or ceilings, electric and pneumatic jackhammers, concrete breakers, hand crowbars and other tools are used. If the equipment is not available or its use is difficult, the littered protective structure must be dug out manually. In these cases, first of all, your help is needed. During rescue operations, it is advisable to divide into small groups (3-4 people each). One group disassembles the debris and strengthens the passage, the other prepares and brings fastening material, the third takes out the debris removed from the rubble.

Keep the soil moist while working. This will keep your clothing from getting radioactive dust on it.

Providing first aid (self-help and mutual assistance) to the injured

First aid to the injured is carried out by sanitary teams, but you should also know the basic techniques of self-help and mutual assistance. To protect a wound or burn from infection and contamination, apply a bandage. For this, use an individual dressing bag, bandage, clean underwear, a napkin, a piece of cloth, etc. Strong pulsating bleeding must be stopped with a tourniquet or twist. First of all, press the artery with your finger against the bone above the wound to stop the bleeding, then, without removing your finger, apply a tourniquet or twist. A tourniquet or twist should not be applied to a naked body (make a soft lining from a piece of cloth), and also kept for more than 1.5-2 hours (in winter – 1 hour). Do not forget to put a note under the bandage indicating the time for applying the tourniquet (twist), so as not to overexpose it for more than the specified period.

If a tourniquet or twist cannot be applied, you need to press the artery with your fingers until the wounded person is taken to a medical facility, where measures are taken to finally stop the bleeding. In case of fractures and dislocations, it is necessary to ensure the immobility of the damaged bones. If the limb is damaged, a splint (board, stick, strip of plywood) should be bandaged to it. Apply the splint so that it captures the joints below and above the bone fracture. A pad of cotton, tow, leaves, moss, etc. should be placed between the tire and the body. If the fracture is open, it is necessary to first apply a bandage to the wound, and then a pad. In extreme cases, bandage the injured leg to a healthy one; if the arm is damaged, it can be bandaged to the body. In the event of a deep faint, as well as a sharp weakening or cessation of breathing, the victim must be given artificial respiration. The most effective method of artificial respiration – “mouth to mouth” – is based on the active blowing of air into the lungs of the victim (active inhalation) and passive exhalation. With a weakening of cardiac activity, an external heart massage is simultaneously performed by rhythmic pressure in the sternum. After providing first aid, the victim must be taken to the nearest medical center. This can be done using a stretcher or using straps and other available means, as well as transferring the victim on yourself.

Operations in areas contaminated with radioactive substances.

The order of actions and the rules of behavior of people in the contaminated area are determined by the civil defense authorities, which report on the nature of the radiation situation and explain how to act. With moderate infection, it is necessary to be in an anti-radiation shelter from several hours to a day, and then you can go to a regular room. When entering the room, do not forget to clean your shoes and clothes from radioactive dust. Leaving the premises on the first day is allowed for no more than 4 hours. Enterprises and institutions continue to work as usual. With a strong infection, you need to stay in the shelter for up to three days; in the next four days, it is permissible to stay in a normal room, you can leave it for no more than 3-4 hours a day. Enterprises and institutions operate under a special regime, while work in open areas is stopped for a period of several hours to several days.

In the event of a dangerous infection, the duration of stay in the shelter is at least three days, after which you can go to a normal room, but you should leave it only if absolutely necessary and for a short time. During the period of radioactive fallout, you should be in shelters. Being outside the shelter, one must remember that the area and all objects on it are contaminated with radioactive substances. In the presence of dust in the air, you need to use respiratory protection. Water for drinking and cooking can only be taken from piped water and protected wells. Water in open reservoirs covered with a thick layer of ice is also not dangerous. Do not use open water sources. In case of emergency, a hole should be dug 2-3 m from the shore of the reservoir, water will seep into it, which, having filtered through the soil layer, will become suitable for use.

Do not consume milk from animals that have grazed on contaminated pastures. It is better to use canned milk (powdered or condensed milk). Foodstuffs stored in refrigerators, kitchen tables, cabinets, underground, in glass and enameled dishes, in plastic bags are suitable for consumption. Potatoes, carrots and other root crops contaminated with radioactive substances should be thoroughly washed and cleaned.