Pneumothorax Surgical

Surgical pneumothorax is the accumulation of air in the pleural cavity, resulting from injury or disruption of the integrity of the chest walls and pleura with the formation of a defect or defect of rib fragments. The boundaries of the pneumothorax are a slit or semicircular hole located directly under the wound of the chest wall or along the line of suture disruption during thoracostomy.

According to severity they are distinguished:

1) Mild pneumotox – percussion sound is determined outside the contours of the lung at one intercostal space. The degree of shortness of breath is within 3 points.

2) Moderate pneumotoach – the level of lung damage is determined by auscultation. The boundaries of the anterior edge of the pneumatox are the transverse ribs, the posterior edge is the spine and the posterior contour of the dome of the diaphragm. Percussion sound is detected beyond the boundaries of the intercostal space. On auscultation, there is no breathing in the area of ​​the corresponding half of the chest.

3) Severe pneumoflow - the transparency of the tissues and the upper surface of the lungs is impaired, there is no breathing, crepitus of the subcutaneous tissue is noted. Dysfunction of the gastrointestinal tract, liver, and kidneys is often noted. Hypotension of the extremities sometimes leads to cyanosis. The blood shows signs of hypovolemia and coagulopathy.

4) Lethal pneumothorax consists of a complete cessation of heart function due to rapidly occurring compression of the heart and deep respiratory tract. The passage of air through them stops. Radiographs show an extensive shadow occupying most of the lung tissue. The heart muscle and lungs do not work, there is no breathing, hemodynamic parameters are not corrected. Intrapleural localization of pneumatox most often causes pneumoremission after a few hours or days. However, lung injury is not always accompanied by the presence of pneumotachus. If damage to the lung occurs after it has been repaired, the pneumotruck does not develop. The clinic for severe lung injury has its own characteristics. This is a shock state of the patient, characterized by cardiac arrhythmias, coagulopathic or hemorrhagic complications, increased bleeding of the skin and mucous membranes, nosebleeds, and internal bleeding often develops. Patients usually experience chest pain.

Treatment of surgical pneumonitis is carried out according to the general rules of surgical pathology. In all cases, early and competent elimination of pneumontachus and a set of rehabilitation measures aimed at preventing serious complications such as collapse, pulmonary edema, shock, and acute pulmonary heart failure are required. Indicated emergency specialized care, refusal

Pneumothorax Surgical for lung injury

**Pneumothorax** is a condition where gas fills the space between the lung tissue and the chest. In this case, the lungs may partially or completely limit breathing function. Pneumothorax can be caused by many causes, including trauma, surgery, or lung disease. Symptoms of pneumothorax include shortness of breath, cough, chest pain and difficulty breathing.

In the case of surgical treatment, restoration of traumatic injuries to the chest walls is required two to four days after the injury. From the moment of suturing, intensive treatment of pneumothorax is carried out. Following this, the cavity is shifted to the middle and lower parts of the chest, which leads to a decrease in the amount of air in this cavity. This, in turn, helps relieve bruises and pain in the chest area.

The incision is made between the fifth and seventh costocostal joint, above the level of the pleura, starts vertically and has a width of 5 to 7 cm. The pleural cavity is divided between two planes, then the pleura is firmly fixed with clamps so as not to damage its surface. Expansion of the cavity occurs by carefully pulling tissue protruding beyond the incision downward. At the same time, a manual acupuncture technique is performed on the entire chest and lungs. This method allows you to restore the integrity of the bone, ensure a rapid supply of oxygen and effective ventilation of the lungs at a low level of pressure (arterial blood is noticeably shifted towards the lungs).

With this technique, there is a rapid reduction in pain. Places of tissue friction are coagulated with liquid nitrogen, this prevents the appearance of swelling when sutures are applied. They can also be frozen with liquid nitrogen before opening the chest. This makes it easier for the other free edges of the cut fabrics to adhere together.

Several expanded cavities allow the air bubble to pass inside. It’s good when there are enough holes in the lungs for ventilation and creating a vacuum using a syringe. Some of them may

**Pneumothorax** is an accumulation of air or gases in the pleural cavity, most often occurring after trauma, chest injury or chest surgery; can be limited or extensive, one- or two-sided. **The thoracic cavity in humans is divided into two sections:** 1) the upper of 3 ribs; 2) the lower of 8 ribs. An unpaired solid cartilaginous costal arch is connected with 2-7 cartilaginous semirings from below. Under it is a loose connective membrane of the pleura (the outer layer of the serous membrane), covered on both sides by the parietal layer of the pleura, which passes to the back surface of the ribs - the pleural sac. The cavity of this sac is filled with fluid, with the exception of a small space in the posterior section (Beaumont's cavity). The posterior part of the common mediastinum forms a triangular-shaped depression - an opening, or a triangular-shaped fissure - the phrenic sinus. Below the posterior part of the phrenic sinus and parallel to the spinal column (to the left and right of the fissure), the thoracic lymph nodes pass, connecting with each other. In the lower lower part of the peritoneal process on the medial wall of the abdomen there is the largest number of lymph nodes - the internal thoracic (parasternal) lymph nodes, in the amount of 6-7 pairs. Laterally from the posterior upper edge of the 4th ribs in a downward direction there are 2–3 pairs of thoracic lymph nodes, rarely more. In the middle thoraco-aorgal angle on the right, it is not always possible to see the small bronchial and left parasternal lymphatic groups. In front of the pleural cavities, the bronchi and the left esophageal opening are visible. Above the diaphragm, covered with it, protrudes the shadow of the diaphragm, on the left under which the spleen and short loops of intestine are visible, and below it the stomach is not very clearly visible.