thoracic exhaust

It is suitable for patients with severe dyspnea and severe lung compression, especially those with tension type pneumothorax. Treatment of diseases: closed pneumothorax open pneumothorax Indication 1. Simple closed pneumothorax, 20% to 30% lung compression and localized pleural effusion. 2. Clinical emergency treatment of tension pneumothorax and other critical pneumothorax. Contraindications 1. Patients with bleeding disorders or who are taking anticoagulant therapy should use it with caution. 2. Patients with severe heart and lung failure should be used with caution. 3. Those who do not cooperate should not be allowed for the time being. Surgical procedure 1. Place the patient in the supine position or the affected side and lean forward slightly. 2. Pumping method. (1) Artificial pneumothorax pressure measurement: Prepare an artificial pneumothorax to check whether the passage and switch are smooth, flexible, and leaking. The pressure-extracting site is determined by the second intercostal space of the ipsilateral clavicle or the 4th to 5th intercostals of the anterior tibial line or according to the chest penetration. In an emergency, puncture in the most obvious drumy area of the percussion. The left hand is fixed to the puncture site, and the right hand-held pneumatic needle penetrates the skin along the upper edge of the rib of the puncture site and slowly enters the needle. At the same time, the pressure gauge is observed. When the needle enters the thoracic cavity, there may be a penetration sensation, and the other end of the pneumothorax needle is connected with the gas chest pump. Porosity, at this time, the liquid level fluctuation in the pressure gauge can be seen. At this time, the gas chest needle is pushed 3~5mm, observe the chest pressure before pumping, rotate the switch to pumping, first pump a small amount of 200~300ml, if If there is no uncomfortable reaction, continue to pump air, and observe the pressure change at any time. When stopping pumping, record the pressure after pumping. Generally, the pressure should be around 0. At this time, the needle should be kept for 3~5min, and the pressure should be observed. If the pressure rises rapidly, suggesting a tension pneumothorax, you should prepare to use other methods to vent. (2) Syringe pumping method: Select 50ml or 100ml syringe, determine the needle position according to the pressure measurement method of artificial pneumothorax, and then repeatedly pump until the patient's symptoms are relieved, and record the pumping volume. For the tension pneumothorax in critical condition, the thick needle can be directly inserted into the chest cavity at the puncture site to achieve the purpose of temporary deflation and decompression. (3) Closed drainage of water-sealed bottle: the same as the puncture point, the trocar is introduced or surgically inserted into the drainage tube, the drainage tube is fixed on the chest wall to prevent the escape, and the outer end of the catheter is connected to the water seal bottle. Closed drainage is divided into continuous positive pressure and continuous negative pressure exhaust. 1 Continuous positive pressure exhaust method: The glass tube for water-sealed bottle exhaust is inserted 2 cm below the horizontal plane. This method is applicable to open or tension pneumothorax, which is beneficial for relieving symptoms and cleft closure. Most pneumothorax can be repaired by itself after 1 to 3 days of continuous positive pressure exhaust. After closing, the water-sealed bottle will escape without bubbles, and it will be clamped for 24 to 36 hours, and then open without any bubble overflow. If the rupture is closed but the lungs are still not re-expanded, the patient can be allowed to blow the bottle (plug a glass tube deep into the water surface and blow out the air bubbles) or blow the balloon to help the lungs re-expand. This should be appropriate for elderly patients with pneumothorax. Do not use excessive force to avoid recurrence. It is not advisable for the patient to blow the bottle or blow the balloon before the gap is closed, so as not to aggravate the condition and affect the healing of the pupil. If the air bubbles continue to escape after 2 to 3 weeks of closed drainage, it indicates that the fracture can not be closed and repaired by itself. At this time, the drug should be injected into the chest for pupillary adhesion or thoracoscopic pneumothorax. 2 continuous negative pressure exhaust method: the drainage tube is connected to the continuous negative pressure exhaust device, maintaining the chest pressure to -0.785 ~ 1.37kPa (-8 ~ 14cmH2O). This method is beneficial for rapid pumping and lung recruitment. It is suitable for difficult and complicated pneumothorax, especially chronic pneumothorax and multi-atrial pneumothorax. In this regard, some scholars hold different opinions, suggesting that it may promote the opening of the pupil, prolong the course of the disease, aggravate the condition, and perform pleural adhesions.