Clinical manifestations
Pneumothorax, mostly in the acupuncture needles during or after the syndrome can occur. Also in the needle after half an hour to several hours seizures, even after 24 hours reported in the needle to accrue typical symptoms of pneumothorax, it is noteworthy. According to the SEC like, pneumothorax can be divided into light, medium, heavy three.
First, the symptoms of pneumothorax
(A), mild pneumothorax: Usually no obvious symptoms, or chest tightness, gas hold, irritating cough, chest stretch activities like pain.
(Two), moderate pneumothorax: Sternocostal tingling, swelling, nausea chest discomfort, shortness of breath, persistent cough strong 5267, palpitations restless, not supine. There are corresponding shoulder, upper extremity painful and limited mobility and so on.
(Three), severe pneumothorax: chest and back side of the needle intense tingling, pain can be the ipsilateral shoulder and arm upward radiation or abdominal radiation, and extreme difficulty in breathing, cold limbs, sweating, irritability, confusion and coma. Such as pneumothorax, more shallow breathing, face pale, pulse rate, blood pressure and other critical symptoms.
Second, the signs of pneumothorax
Mild pneumothorax, obvious signs. Moderate to severe pneumothorax, respiratory rate accelerated, increased heart rate, may have nose flap. Trachea and apex beat both toward the contralateral, ipsilateral intercostal space full, bulging thoracic breathing activity and fremitus decreased or disappeared. Percussion was too voiceless or voiced drum sound. Breath sounds diminished or disappeared, contralateral breathing sound enhancement. Orthopnea, cyanosis. Pneumothorax, in the ipsilateral effusion at real percussion sounds. Examination shows ipsilateral response was excessive percussion, alveolar breath sounds or disappeared, chest wall subcutaneous product gas, there are severe tracheal shift. Chest or film visible pneumothorax and lung tissue compression elephant. Some patients in the acupuncture was no obvious symptoms, a few hours after the gradual emergence chest tightness, shortness of breath, chest pain embolism.
Three, X-ray
Pneumothorax part through increased brightness, no pulmonary veins, pulmonary hilum to shrink into a transparent mass, its edges visible fat linear shadows visceral pleura. Lung atrophy from 10 to 90% range. Such as pneumothorax, the visible liquid surface.
Chest X-ray photo: ipsilateral lung permeability increased brightness, markings disappeared seven cases and three cases of pneumothorax was seen when the general physical examination shortness of breath, increased frequency and increased heart rate. The group of one case of bilateral pneumothorax visible cyanotic lips, nose flap, three depressions dyspnea. Unilateral pneumothorax in patients with tracheal shift to the contralateral visible. Chest examination: palpation ipsilateral fremitus diminished or disappeared, percussion drum sound ipsilateral, ipsilateral lung auscultation breath sounds diminished or disappeared. If left in severe pneumothorax, percussion left heart border disappears, auscultation apex distant heart sounds.
X-ray examination, lung collapse and confirm the presence and severity of pneumothorax. Not only can confirm the diagnosis, but also to guide treatment options.
Some scholars, for 14 cases of pneumothorax were analyzed as follows. Symptoms: Among 14 cases of dyspnea (100%), chest pain, 12 cases (85.7%), cough, 8 cases (57.1%), syncope, pale, cold sweat dripping 6 cases (42.8%), upper abdominal pain in three cases of lightning-like ( 21.4%), fever (38 ~ 39 ℃) 3 cases (21.4%). Duration of 1 to 2 days in 8 cases symptoms on admission, the other six cases of disease symptoms gradually reduced.
Signs: mild cyanosis four cases (28.5%), were more than 60% of cases of lung compression.
X-ray: 14 cases of chest radiographs for the diagnosis are based on a deep gas. Compression level: mild (compression <30% = 8 cases, moderate (31 to 50%) 3 cases, severe (> 50%) in 4 cases. Pneumothorax type; were closed type. Pleural effusion: a small amount (rib every angle obtuse) nine cases. in the amount of (full rib intercostal muscle to the second before the following) four cases. 8 cases of pleural effusion Upon examination: exudative 3 cases, 3 cases of purulent, bloody two cases [4].
Showed symptoms of dyspnea, chest pain, cough, syncope common. X-ray: shows the degree of compression with mild common.
When such an accident, in order to try not to delay treatment and reduce patient moving times, unless disease complex, generally based on a needle piercing deep provincial governor, chest pain, breathing difficulties and other typical symptoms, can be confirmed. Have that perspective is not conducive to the patient immediately, should be in stable condition, before making perspective.
Finally, we must emphasize that the cause should be avoided misdiagnosis. One of the most easy and fainting symptoms of confusion. Where a female patient, 59 years of age. Due to chronic bronchitis, cough, expectoration and whom acupuncture Feishu, Dingchuanxue, promises about 15min after the needle, the patient complained chest tightness, dizziness, did not cause healer attention. On the back of the needle and then cupping, patients are becoming urgent breathing, bluish lips, thought it was caused by fainting, then open the window ventilation, Roll fan blowing, etc., but disease situation continues unabated. Was suspected pneumothorax. Radiologists perspective see 50% of lung compression, rushed superior hospital, and finally on the same day due to rescue invalid death [5].
In addition, some bilateral pneumothorax is often misdiagnosed as unilateral, such as one case of pneumothorax caused by acupuncture patients hospitalized afternoon, found only on the left chest clinic pneumothorax and lung expansion is good. Applied immediately after admission the left thoracic drainage, postoperative lung expansion 4h chest review the situation, they find that there are right pneumothorax, lungs were compressed from 30 to 50%. So, not only to observe acupuncture patient, the patient should be observed after acupuncture more changes, even in the beginning stages of treatment, nor should relax dynamic observation had needled contralateral breast without pneumothorax.
[Prevention]
First, the use of percussion techniques: Many needlestick injuries caused by pneumothorax and lung in a pathological state related. Therefore, for the first time in the chest and back needles were applied, should be set to percussion lung lower bound. On the inspection side of the pulmonary lesions, the lower bound of bilateral lung measured mobility, and make a mark, and then decide acupoints and needling depth.
Second, grasp the back of the chest Acupuncture techniques: clinical, back acupoints applied frequency is higher. It is necessary to strictly control the depth of the needle, but also get results. According to the experience of most physicians, piercing the effective depth is not easy to master, so the use of the following methods: On the outside of the back acupoints about 1cm at the needle to a 65 ° angle with the horizontal needle, deep puncture to the spine direction. Until the tip touches the vertebral body, and then briefly quit, implementation practices. This method is not only safe, but also a strong sense of qi. In vertebrae as a symbol, do not worry about deep piercing the chest, and due to a 65 ° angle piercing needle through the hole, the depth has reached more than 2cm, equivalent to the depth required acupoints back to near the spine and stabbed Huatuojiaji hole, through the hole with features, it has a better therapeutic effect. Chest acupoints may be made to the costal margin obliquely to the bone, a slight effect after exiting techniques, such as the need piercing, should be sent to the needle slowly, only scoring 3 to 5 minutes, acupuncture as not significant, no longer deep puncture, should be in a small explore within the range of lift and thrust, lift and thrust in the range of 1 ~ 2mm or so. If still not clear, the needle should stop waiting gas, 3 ~ 5min before the law to spend to stimulate acupuncture.
Jian Jingxue higher frequency of occurrence of pneumothorax, and its difficult to grasp the depth, because Jian Jingxue recent apex, the walls of the visceral pleura cavity region fibrous trabeculae, the scope of activities is extremely small, and the right border and the right pleural ago a small gap between the lungs, coupled with the previously mentioned pleura pleural sac uppermost roof, above the inner end of the clavicle above 1 ~ 3cm, so acupuncture Jianjing Xue, especially the right to pay great attention, not too deep and to repeatedly experience feel. Acupuncture needle should be tilted to the outside to prevent the internal oblique and apical pleural puncture.
Third, the selection of points should be carefully considered set of square: beginner to minimize election shoulder, back, chest acupuncture points, can Jiaji on behalf of, or all the way acupoints. Such as patients with emphysema and other diseases, even if there is some clinical experience, physicians should also be careful to take chest, back acupoints.
Fourth, prepare needle preparation: should choose the needle straight and smooth, such as needle bent, if lung injury, increasing the gap easily. Needles and syringes should be fine, with 28 to 32 needles. So that patients take volts sitting or lying position, Nursing and needle not any movement. Charges hands should be light, in order to avoid accidents, minimize the use of charge hands. Applying warm needle, should hand held onto the needle in one hand and twist loading moxa cone to prevent needle deep shift. Put an end to every garment needle. If a male patient, 45 years of age. And as a result of stiff back, sour acupuncture treatment, take the prone position across the shirt into the needle, take 1-5 Huatuojiaji chest and throttle, Feishu, Dazhu various points, needle Jiayi cone temperature needles, moxa cone was lit shortly patients that dizziness, lightheadedness, see the urgent breathing, lip slightly purple. Anxious the needle, sending radiology examination, the left lung is compressed 40% [5].
In addition, generally do not tank after the needle, such as emphysema patients, but also to prohibit.
Five, the needle during observe. Shoulder, chest, back acupoints needle retention time not too long, under normal circumstances not exceed 30min. The needle during the medical staff should strengthen the observation, asked the patient can not be arbitrarily changed position. Because needle retention time is too long, the patient is often difficult to maintain a fixed position. And any change of position, which can cause the needle to move within the body at points, increasing the possibility of occurrence of pneumothorax. It was reported in an outpatient, day cases on its back and a large loom buried the needle hole, due to medical negligence, the patient themselves out, 2h round trip to the clinic and found pneumothorax.
Six, attention needle observation: Where acupoints acupuncture patients chest and back, where possible conditions, should be allowed to rest in another clinic after 15 ~ 30min walk, so group of patients in a few hours or even ten hours after the needle, the sudden appearance chest pain, cough and shortness of breath and other symptoms, and with no other obvious cause, should be suspected pneumothorax possible.
In addition, shoulders, back, chest election acupuncture, if sudden shortness of breath, chest disease, or “collapse”, you should first think of traumatic pneumothorax complicating the issue. There are many patients, the needle immediately after “syncope” and was mistaken for a local doctor “fainting.” Therefore, any “fainting” Patients must further examine the problem clearly pneumothorax. With chronic bronchitis, emphysema and elderly frail, thin chest wall who pay special attention to the chest acupuncture.
[Processing Method]
A general treatment
1, quiet rest.
2, drug treatment. In observing the course of treatment for the prevention of chest infections, routine use of 400,000 units of penicillin, streptomycin 0.5g, intramuscular injection, twice daily. To have the fever and small amount of pleural effusion, and increase the amount to 80 million units of penicillin twice daily intramuscular injection. Such as penicillin and streptomycin allergy, you can use gentamicin, intramuscularly, every 80,000 units twice daily. Cough, to give antitussives, to prevent continued leakage.
3, the exhaust pressure. All patients in the acupuncture shortly after (1 ~ 2h) significant chest pain, dyspnea, pulmonary shrink more than 20%, the pleural cavity was positive by (or on the diagnostic when tried, pintle is natural gas ejection) by gradually increasing trend observed symptoms should be immediately vented. Used as follows.
1) Puncture Exhaust: easy to operate, especially in the case of an emergency condition, available immediately exhaust side clavicular line in the second intercostal space disease, the use of artificial pneumothorax is puncture exhaust.
2) closed drainage Exhaust: The majority of pneumothorax caused by acupuncture, for the simple closed pneumothorax, usually after exhaust after puncture wounds can heal quickly. But there are a few patients puncture ineffective, such as clinical symptoms and chest X-ray confirmed and manometry showed improvement after puncture was aggravated, you need to make further and chest tube drainage and so on.
Second, according to disease treatment
1, mild pneumothorax: patients with no obvious shortness of breath, cyanosis injured side after acupuncture only mild chest discomfort, shortness of breath after the event, to diagnosis time has passed for more than 24h, the X-ray diagnosis of lung atrophy in 10 to 15% less than those, And without emphysema and other lung lesions, and no pneumothorax hinder the natural absorption of the primary disease, usually 5 to 7 days of bed rest. According to disease discretion to antitussive, analgesic agent. To prevent infection, antibiotics may be considered appropriate. General gas and more self-absorbed and more, but need to pay attention to observe, to prevent the symptoms suddenly worsened. If conditions, could give patients with sustained low on flow oxygen or high concentrations of oxygen masks.
2, moderate pneumothorax: pulmonary shrink more than 15% but less than 30%, or accompanied by emphysema and other diseases, and even if the patient should rest in bed, keep quiet. Artificial pneumothorax is the second intercostal space in the midclavicular line or ipsilateral axillary line 4 to 5 ribs, puncture exhaust after routine disinfection, each having all drained to intrathoracic pressure from “0” up and down prevail. No artificial pneumothorax is for emergency purposes, these parts can be disinfected with an empty 50ml syringe pumping; or with the general thrust needle in the needle tail tied a finger, after disinfection, the needle piercing the chest, and then cut a finger tip 2 ~ 3mm big small mouth, to exclude air.
Mild to moderate pneumothorax, you can try with WAA treatment. Take on a wrist treatment sites, on two points. Line 1 is located on the inside of the ulna and the ulnar flexor carpi, the last two in the tendon and flexor carpi radialis tendon that Neiguan on. On one, the two points are in the 2-inch wrist crease acupoints selected treatment sites, the treatment of skin and needle point routine disinfection, with 30 to 32, 1.5-inch stainless steel needle, needle body should be straight, tip and skin was a 30 ° angle into the needle, when the needle through the skin, the needle is about flat, close to the skin surface, along a straight line to the needle hypodermic needle shank roots, in the course of the needle, needle through the skin unless there was a slight tingling In addition, requirements do not cause any discomfort or need to adjust the direction of the needle or shades. Acupuncture a day, every needle more than 2h, to achieve the best results needle retention time may be extended up to 12h. The needle in the course of therapy, the patient should not have any feeling best. Treatment effect with the judgment of lesions, the treatment site selection and direction of the needle, the depth is closely related to the degree of accuracy, or affect the results. It should be emphasized that this therapy after the needle must be immediately effective, immediate relief of symptoms or disappear, or is invalid, they should immediately take other exhaust method, so as not to delay the rescue time, resulting in life-threatening to the patient [6].
3, severe pneumothorax; right chest showed the lung is compressed 40% or more, and patient symptoms, especially in hypertensive pneumothorax, and use the emergency law often only temporary, until the disease situation has stabilized, they should immediately turn surgical treatment, such as the use intercostal incision closed chest drainage and other facilities. Since a large number of product intrathoracic gas is drained, the patient often in a significant improvement in clinical symptoms. With the continuous discharge of gas accumulation, lung can gradually recruitment. If the chest X-ray shows lung has re-expansion, the injured side lung breath sounds has been restored, close observation of the drainage tube drainage tubes were removed only after 24h.
4, blood, pneumothorax in the above on the basis of therapeutic measures, with the extraction of blood or pleural effusion. If shock symptoms, should be compatible with blood transfusions, anti-shock therapy. Blood out than those who shall be promptly transferred surgery to stop bleeding.
It should be emphasized that the serious and more serious pneumothorax is a medical emergency. Improper acupuncture pneumothorax is often the primary disease did not improve, but outstanding performance pneumothorax as the principal contradiction. In this case, some families and patients because of panic, or some medical staff lack basic knowledge of treatment, the patient is often far away from the countryside into the city hospital. Thereby increasing the suffering of the patient on the way, or even life-threatening. Because patients with multiple system generally simple pneumothorax, it should be handled locally based. Severe pneumothorax must be transferred by the referral process before or referral necessary pleural exhaust. Escort medical personnel shall carry thoracentesis utensils to prepare the way exhaust, in case of emergency puncture needle needle in a general tail tied to a finger, sterilized piercing the chest, the chest wall fixed with adhesive tape, and then the finger top cut a 2 ~ 3mm holes, to solve the emergency exhaust to prevent unexpected way.