Pneumothorax, what exactly is pneumothorax?
The word pneumo means air. Thorax is that area of the body commonly called the chest, where the lungs are. Together, they stand for the condition in which free air is outside the lungs, within the thorax area and causes the lung to collapse.
Types of pneumothorax:
Spontaneous. Also known as a primary pneumothorax, occurs without the presence of any trauma or known lung disease.
- Caused by the rupture of a cyst on the surface of the lung. The reason for the formation of these cysts is uncertain, but the rupture often occurs when the person is scuba diving, flying or mountain climbing at high altitudes.
- Puncture injury such as fractured rib, gunshot or knife wound; inadvertent puncture during surgery, a lung biopsy or the insertion of a chest tube.
- Blunt trauma as in a car accident, physical assault.
Complicated. This is known as a secondary pneumothorax. It is the result of an underlying condition or disease. Damaged lung tissue is more likely to collapse. Common underlying conditions include.
- Cystic fibrosis
- Lung cancer
Severe. When the person in receiving mechanical assistance to breathe and an imbalance occurs causing the lung and heart to be squeezed and unable to function properly. The following may occur.
- Low blood oxygen levels occur (hypoxemia)
- Cardiac arrest
- Respiratory failure
Symptoms of a pneumothorax:
- Chest pain. Sudden pain occurs on the side of the affected lung and it does not worsen with normal breathing but can be worsened by a deep breath or cough.
- Shortness of breath. This may be mild or severe, depending on the degree of the collapse, and also is dependent on any underlying lung disease.
- A large pneumothorax will also include chest tightness, easy fatigue, rapid heart rate and a bluish color of the skin caused by lack of oxygen.
Diagnosis of a pneumothorax:
- No breath sounds are heard on the affected side by a stethoscope.
- Chest x-ray will show air outside of the lung
- Computerized tomography or CT gives a more detailed view of the lung.
- Arterial blood gas, commonly known as an ABG, will denote the level of oxygen in the blood.
Treatment of a pneumothorax:
The main objective is to relieve the pressure on the lung so it may re-expand. Treatment of a small collapse can be as simple as monitoring until the outside air is reabsorbed by the body. Bed rest without any real exertion may be enough. Supplemental oxygen can sometimes speed up the absorption.
Other treatments include:
- Inserting a needle. A hollow needle with a syringe is inserted between the ribs into the air-filled space. The syringe is used to pull out the excess air in the same manner as drawing blood from a vein.
- Using a chest tube. The chest tube is attached to a suction device and continually removes the air from the chest cavity. This may be used for several hours or even several days.
- Surgery. If the chest tube is not effective, the air lead from the lungs will be closed by surgery, using a fiberoptic camera and long-handled narrow surgical tools.
- A person’s sex. Men are more susceptible than women
- Smoking. The length of time a person has smoked, even in the absence of emphysema
- Age. Those people, who have developed air blisters, are most susceptible between 20 and 40 years of age, especially if they are a very tall and underweight man.
- Genetics. Certain forms of pneumothorax run in families.
- Lung disease. Emphysema, pulmonary fibrosis, cystic fibrosis and sarcodosis.
Having once experienced a collapsed lung, a person’s chances of it happening again are increased. There is no way to prevent it from happening again, but definitely stop smoking if you are a smoker.
The Importance of Sleep for Health and Survival
Sleep is necessary for survival. It is that period of the 24-hour day when the body has a chance to rejuvenate. Sleep is what enables a person to keep going day after day. It makes it possible for them to work, function at a high level, also enjoy life and their surroundings.
The American Sleep Association states that the understanding of sleep’s role in life has become much deeper since the 1950s. Scientists have learned about neurotransmitters or nerve-signaling chemicals that control whether a person is a wake or asleep. These neurons need to be able to shut down and repair themselves. The energy used during a person’s wake time must be built back up. During sleep, cells of the body show increased production and reduced breakdown of proteins during deep sleep. Protein is the building block needed for cell growth and for repair of damage from stress.
Sleep is an active state. It affects both the physical and mental well being of everyone. Deep sleep produces growth hormones in children and young adults. The part of the brain that controls emotions and the decision-making process as well as social interactions is almost totally shut down. This gives the brain a chance to rest from these functions.
The results of too little sleep can cause:
- Impaired memory and thought processes
- Decreased immune response
- Increased pain perception
A description of what is needed to record sleep taken from the Sleep Apnea Guide site:
“To collect all the signals from a sleeping person, the sleep doctors use sophisticated equipment, very expensive, called polysomnogram. This equipment is like a computer, with additional systems, such as:
- an electroencephalogram (EEG) – which records the brain wave activity
- an electrooculogram (EOG) – which records the activity of the eyes
- an electromyogram (EMG) – which records the muscles activity
- an electrocardiogram (ECG) – monitors the heart rate and rhythm.
- body movement detector – the patient will have a couple of electrodes placed on the muscles of the shins, together with a body position sensor around the waist.”
A video so you can see what happens during a sleep study is also found on the Sleep Apnea Guide site
Now a breakdown of the stages of sleep and what is experienced during those times. The first four stages of sleep are called NREM or non-rem sleep. Each stage lasts from 5 to 15 minutes. All the descriptions are taken with the equipment listed above.
As seen in this image, the awake stage has a narrow and very active zig-zag action, tight up and down line formation. This will change as the person goes through the various stages of sleep
Stage one: Theta Waves
At this level, a person is beginning to unwind. Their eyes are closed and a reduction of activity is seen in the brain. They slowly drift in and out of sleep. Some people feel sudden muscle contractions known as hypnic myoclonia, a response similar to when a person is startled. The brainwave seen in this stage, while still close together, is starting to become irregular; with more varied length up and down strokes.
Stage two: Light Sleep
The second stage is a very light level of sleep. The lines on the polysomnograph start to show intermittent peaks and valleys also known as positive and negative waves. They indicate moments of spontaneous muscle relaxation. Heart rates begin to slow down and temperatures will decrease. While a person can be easily woken during this stage, they are no longer in a state of awareness.
Stage three: Delta Waves
Deep sleep is now going to begin. A person is not easily awoken from this cycle. It is the start of the most crucial stage of the sleep, as it is the restorative stage. The brain waves are becoming more regular and slower.
Stage four: Delta Waves
Now the individual has truly entered deep sleep. There is no eye or muscle movement. Brain waves become slow and spread apart. The body begins to repair itself. The immune system becomes more active and vital hormones are activated. The growth hormone is important in adults as well. It rebuilds muscle mass, converts calories into muscle mass, and repairs muscle.
When there are continued disruptions to this third cycle, health problems may develop. Poor restorative sleep means less growth hormone and calories become fat instead. This has demonstrated the need of deep sleep to prevent obesity.
Disruptions can be from environmental factors (too cold or too hot). There can be physical factors such as needed bathroom visits. Stress can also be involved. There is also sleep apnea. This is when the throat closes and prevents breathing. At this moment the person will snore heavily, jerk awake, gasping for air.
Finally the REM stage
REM stands for rapid eye movement. This is the dreaming stage. It is during this time newly learned knowledge is put into memory. Experiences from the day are ‘reviewed and filed away.’ REM is needed for mood regulation and its absence is the cause of depression and other thinking disorders. Brain waves quicken and resemble stage one. The heart speeds up. The eyes move rapidly in different directions. The body and the muscles remain quiet, immobile, temporarily paralyzed.
The passage from stage one to REM is considered one cycle and it lasts from 90 to 110 minutes. A person may experience four or five cycles each night. In the beginning, more time is spent in stages three and four, but towards the end of the sleep period, more time is spent in REM. Infants spend up to 50 percent sleep in REM. Adults spend about half of their time in stage two, 20 percent in REM and 30 percent in the other stages.
The Vestibular System and Balance
The vestibular system is minuscule in size when compared to the reparatory or neurological systems, but any abnormality within this system can cause major problems. It is involved in maintaining balance, posture, as well as a sense of orientation in space. It enables an individual to stand, focus on a singular object even when moving as well as being able to move without falling. That is quite an impressive job for such a small system.
The system location and structure:
Looking at the structure of this system, it seems like a maze set into the middle ear, called the labyrinth. This maze is made of bone, soft tissue as well as an intricate cluster of loops, pouches and the otolithic organs. At the opposite end there is a snail-shaped organ, the cochlea, which enables hearing.
The vestibular system needs other organs in order to fully function. It connects to other sensorimotor systems of the body; the visual system (eyes), the skeletal system (bones and joints). When it comes to maintaining the position of the body, the vestibular system detects mechanical forces such as gravity that affect movement.
The three fluid-filled semicircular canals that are arranged at right angles to each other, tell the brain when the head rotates or move makes a circular movement. At the base of these canals there is a base containing a raindrop-shaped structure called the cupula. These chambers are filled with a viscous fluid and small particles called otoliths. Movement causes the particles to move over small hair cells called stereocilia, in the cupula.
There are two other fluid-filled pouches located between the cochlea and the semicircular canals. They are the utricle and saccule, whose job is to let the brain known when the body is moving in a straight line; in the act of standing up, ride in a car or bike. They also tell the brain the position of the head when sitting up, leaning back or lying down, again using their awareness of gravity.
Here too there are sensory hair cells (stereocilia) and also grains made of calcium carbonate called otoconia. Again, as the head tilts, gravity causes the grains to move the stereocilia, which signals the position of the head to the brain. All this interaction of particles within the small fluid-filled pouches of the vestibular system work with the brain as it works in conjunction with the eyes to keep the vision clear, and not blurry. The sensory receptors of the skeletal system also respond to the signals of the vestibular system to help keep balanced, whether still or walking. The brain processes all these signals in order to control balance.
The National Institute of Health, in the division on “Deafness and Other Communication Disorders,” lists the symptoms of a balance disorder. It is quoted below.
“If your balance is impaired, you may feel as if the room is spinning. You may stagger when you try to walk or teeter or fall when you try to stand up. Some of the symptoms you might experience are:
- Dizziness or vertigo (a spinning sensation)
- Falling or feeling as if you are going to fall
- Lightheadedness, faintness, or a floating sensation
- Blurred vision
- Confusion or disorientation
Other symptoms are nausea and vomiting, diarrhea, changes in heart rate and blood pressure, and fear, anxiety, or panic. Some people also feel tired, depressed, or unable to concentrate. Symptoms may come and go over short time periods or last for longer periods of time.”
Types of balance disorders:
There are a number of different balance disorders. Some are temporary and others are chronic. Various medicines can also cause imbalance problems. Several are listed and briefly explained below.
- Labyrinthitis: inner ear infection that may accompany an upper respiratory infection.
- Meniere’s disease: connected the the fluid volume within the inner ear
- Positional vertigo: a brief but intense episode of vertigo caused by certain movements
- Vestibular neuronitis: inflammation of the vestibular nerve, sometimes caused by a virus.
Diagnosis is not always easily done. An otolaryngologist or Ears, Nose and Throat doctor, commonly called and ENT usually does the tests. These include a hearing test, blood tests, an electronystagmogram, cat scans or MRIs as well as a posturography.
Times to seek help:
As listed on the National Institute of Health site, here are questions that may help an individual determine if they need to medical seek help.
- Do I feel unsteady?
- Do I feel as if the room is spinning around me?
- Do I feel as if I’m moving when I know I’m sitting or standing still?
- Do I lose my balance and fall?
- Do I feel as if I’m falling?
- Do I feel “lightheaded” or as if I might faint?
- Do I have blurred vision?
- Do I ever feel disoriented, such as losing my sense of time or where I am?
A balance disorder is not something to ignore. It can be diagnosed and treated. Some changes in lifestyle may be needed. There are things that can be done within the home to help prevent falls. Low-heeled shoes, use of a cane may be needed for some disorders. Certain condition at work may need modification, perhaps just temporarily. Driving may be hazardous. Not all disorders are permanent if a proper diagnosis is made and proper treatment is given.