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Lung emergencies – how are they treated?

Guide to respiratory problems and treatment

The ultimate lung emergency occurs when someone stops breathing and requires emergency resuscitation. Other acute lung problems that need urgent medical attention include having an accident or injury that leads to a collapsed lung, having a blood clot trapped in one of the blood vessels in the lung, and having a blockage in the main airway. Treatment for all these lung problems is possible, but needs to be carried out quickly and expertly.

 

Treating a collapsed lung (a pneumothorax)

Normally, lungs are able to take in and expel air because they are surrounded by the pleural membranes, which creates a sealed vacuum. If this seal is broken, as it may be after a car accident or stab wound, air can get into the space within the membrane but outside the lung.

 

The pressure from this external air is too much for the delicate lung tissue, and it becomes impossible to inflate the lung. When this happens the lung collapses, and this is known as a pneumothorax. Symptoms of a pneumothorax include sharp pain, difficulty breathing and feeling very tired and anxious.

 

Treatment for a pneumothorax involves:

 

  • Giving oxygen and allowing the lung to recover on its own. This is suitable only for a small pneumothorax

  • Inserting a tube between the lung and the pleural membrane to remove the excess air so that the lung can start to inflate again. Oxygen is usually also given to help with symptoms

  • Surgery to repair the damage and to prevent the lung collapsing again.

 

Treating a pulmonary embolism

A pulmonary embolism is a blockage in one of the arteries that takes blood into the lungs. Just as a blockage in one of the coronary arteries leads to the death of heart tissue and a subsequent heart attack, a pulmonary embolism can lead to the death of large amounts of lung tissue. This can be rapidly fatal.

 

The artery in the lung can become blocked by:

 

  • A blood clot: it is common for people who are ill for a long period and immobile in bed to develop clots in the deep veins in their legs. This can lead to deep vein thrombosis, and part of one of the blood clots can break off and travel to the lung, lodging in a lung artery

  • An air bubble or particle of talcum powder: this type of pulmonary embolism can occur in intravenous drug users, as air or talc is introduced into a vein by a poor injection technique.

 

As most cases of pulmonary embolism are caused by blood clots, the main therapies include drugs to thin the blood and break down the clot:

 

  • Anti-coagulant drugs such as heparin and warfarin are used to thin the blood, so that it can flow more easily past the obstruction

  • Thrombolytic drugs such as streptokinase can be used to break down the clot but this has to be done carefully as the clot can break into large pieces, some of which may travel to the brain and cause a stroke

  • Surgery: this is only used in a few patients who are suitable; more operations used to be done to try to treat pulmonary embolism but these were often unsuccessful so are no longer recommended.

 

Treating acute respiratory distress syndrome

Acute respiratory distress syndrome is an umbrella term used to describe the state of someone whose breathing has become very difficult. They are anxious and may show signs of blueness around the lips and in the skin of their hands and feet.

 

This may be because of an accident, almost drowning, drug or alcohol abuse, inhalation of vomit or other substances that are damaging the lung tissue, or acute lung infection such as pneumonia. Typically, acute respiratory distress syndrome develops within a day of the injury or the onset of serious symptoms due to infection.

 

Treatment usually requires admittance to an intensive care unit, and respiration support. The patient is intubated and a respirator controls their breathing, the pressure of gas going in and the amount of oxygen delivered to the lungs.

 

The underlying cause of the lung problem then needs to be tackled. In the case of trauma, surgery to repair the damage may be necessary. For severe lung infections or inflammation, treatment with antibiotics and/or corticosteroids is usually started immediately.

 

Treating a blocked airway

The main airway can become blocked by food or a foreign object and someone who is choking needs immediate help to dislodge whatever is causing the problem. Most first aiders are now trained to perform the Heimlich manoeuvre, in which the diaphragm is given several sharp thrusts from just under the ribs. This forces air upwards, hopefully removing the foreign object.

 

If an object is too small to block the airway, it may become lodged in one of the bronchi or further into the lung. This often happens in children who inhale watch batteries or earrings after they put the objects in their mouth. The position of the object can be revealed in an X-ray and an endoscopic retrieval system is then used to remove it.

 

Parents of small children may also make an emergency visit to an A&E department because of breathing difficulties caused by croup or epiglottitis:

 

  • In croup, infection causes the airways to swell and, in a small child, the small airways can start to close up. This causes the loud rasping noise when the child breathes and coughs. Usually, the problem is temporary and can be relieved by bringing the child into a steamy atmosphere, but occasionally the croup is severe and the child needs to be intubated so that they can breathe until the inflammation has passed

  • Epiglottitis is swelling of the epiglottis due to infection. Again, as a small child has only a small throat and airways, the tissue can get so large it completely blocks the top of the trachea. This usually requires immediate intubation and treatment to reduce the swelling.


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