Sudden pain and tightness in chest can be an attack of "pneumothorax", especially in "thin and tall" young people.
Pneumothorax, or collapsed lung, is one of several life-threatening medical emergencies that can result from a penetrating chest injury or lung barotrauma.
AnatomyThe lungs are located in chest cavity, in hollow space. Air enters lungs through a powerful abdominal muscle called diaphragm, which separates chest cavity from lower internal organs. The pleural cavity is area between chest wall and lungs. When air enters pleural cavity, either from outside or from lungs, lungs may collapse and victim cannot mechanically breathe even with clean airways. If a sheet of tissue forms a one-way valve that lets air from lungs into the pleural cavity but cannot exit, then each breath creates excess pressure, and this is a tension pneumothorax. This can cause severe shortness of breath as well as circulatory collapse, both of which are life-threatening.
A small lung chest usually resolves spontaneously and does not require any treatment other than clinical observation. A large or tension pneumothorax may be a medical emergency.
cause of pneumothorax
Common causes of pneumothorax are penetrating chest injuries, excessive atmospheric pressure, and pre-existing lung disease; Pneumothorax can also occur spontaneously for no apparent reason. A tension pneumothorax results from an intrapulmonary injury that does not penetrate chest wall, or from an improperly bandaged penetrating wound to chest. In rare cases, it may be caused by a lung disease such as advanced pneumonia or lung cancer.
Diagnosis of pneumothorax
People with above injuries are unable to breathe, even if their airways are clear. They may spit up or cough up blood. They will turn "blue" and lose consciousness. Immediate medical attention is required within a few minutes, otherwise victim will die. There may be only one wound (entry wound) or two wounds (possibly also an exit wound). Both must be treated.
Treatment of pneumothorax First aid
Standard first aid procedures involve dressing wound with a pressure bandage and sealing it with petroleum jelly or clean plastic wrap. Aseptic packaging in plastic bandage bags is fine, but any sealing material will do, even cellophane from cigarette packs.
Important: Do not cover hole completely. Keep valve or angle open so that air does not accumulate in lungs, but patient can still breathe.
Any patient with a penetrating chest injury should be monitored closely at all times and may develop a tension pneumothorax or other life-threatening respiratory illness at any time. Don't leave them alone even for a moment.
Nursing in the field (first responder)Use an airtight compression bandage as above. Provide oxygen therapy. Use caution and follow local regulations when using positive pressure ventilation and bag valve masks. Even conscious patients may require intubation. Extended medical assistance and immediate evacuation are strongly recommended.
Be careful with tension pneumothorax. Additional treatment for tension pneumothorax involves making a small incision in chest cavity with a large cannula that can be closed or opened as needed.
DANGER: When evacuating to mountains or by air (MEDEVAC), be aware of effect of altitude changes on patient. If patient becomes short of breath immediately after changing altitude, immediately return to original altitude. This may require a series of short helicopter "jumps" until a road for ground ambulance transport is reached.
Clinical treatmentImmediate surgery to close a hole in chest and/or lung. Adjuvant therapy, including mechanical ventilation. Long-term hospitalization, including respiratory therapy, is possible.
Sudden pain and tightness in chest can be an attack of "pneumothorax", especially in "thin and tall" young people.
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