Pneumothorax or not - Part two.

[Uncle Frank]

Firstly thanks to those who responded to my first thread back in February. To cut a long story short I was assaulted last year and suffered a stab wound to the right side of my chest which caused a small pneumorthorax. I have since received conflicting advice as to my future suitability for diving so I submitted myself for a second CT scan in March of this year. The report from the first CT scan reported finding pulmonary laceration and a small pneumothorax.
The report from the second CT scan reads as follows:
"There is a 3mm subpleural nodule in the right middle lobe lateral segment which is too small to charactersie and could be post inflammatory in aetiology. The lungs are otherwise clear. There is no significant scarring evident in the right lung anteriorly to suggest sequelae of the previous pulmonary laceration. There is no pneumothorax. There is no pleural effusion. There is no significant lymphadenopathy. The visualised upper abdominal organs show no significant abnormality. No bony abnormality is evident."
This has been run this past a couple of doctors who have said that while all looks ok maybe I should talk to someone else.
I have come to the concluson that nobody is going to give me an all clear to dive again simply due to the fact of possible litigation if anything goes wrong. With this in mind I am going to go for a shallow splash (5-6m) with a couple of good dive buddys and see what happens.
I have two questions to put to the forum:
1. What would I be feeling if a spontaneous pneumothorax was about to occur or has occurred?
2. What first aid should a dive bubby perform?

Thanking everyone in advance,
Uncle Frank

 

[DocVikingo]

I have two questions to put to the forum: 1. What would I be feeling if a spontaneous pneumothorax was about to occur or has occurred? 2. What first aid should a dive bubby perform?

Hi Uncle Frank,

In short:

1. You likely will feel nothing and have no warning signs.

2. The first step in dealing with this emergency is to get the diver to the surface and immediately summon the EMTs. In the interim, check for shock and treat if present, make sure the airway remains open and administer 100% 02 by mask.

No doubt TSandM will have more extensive and sage advice.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such. Consult with your physician before diving.

 

[TSandM]

You may feel some chest pain on the affected side, or an urge to cough, or some mild shortness of breath. Spontaneous pneumothoraces are sometimes completely asymptomatic, but often do have some symptoms.

The danger in diving incidents is not simple pneumothorax. Absent major underlying lung disease, most people cope pretty well with a simple pneumo. (I've had patients show up in the ER where the history makes it clear that they've been walking around with a collapsed lung for several DAYS.) The danger with PTX underwater is that the air that escapes from the lung will expand while you ascend, because it can't get out anywhere. This causes what's called "tension physiology", where the expansion of one side of the chest physically pushes the heart and great vessels over to the other side, kinking the vena cavae and reducing blood return to the heart. No blood return = no blood pumped forward, and the patient goes into shock. The only field treatment for this is to relieve the pressure by making a hole in the chest wall on the affected side. Paramedics do this with a large gauge needle with a latex valve on it, so air can get out, but not back in. If you make a big hole in the chest and don't have some kind of valve on it, then when the patient tries to inhale, air just comes in the hole and not down the trachea, so this is NOT a benign intervention, and should NOT be considered by lay people who are unsure of the diagnosis and don't have correct equipment.

Honestly, your risk of pneumothorax after a simple pulmonary laceration is very low. Please don't sue me, but I really wouldn't worry about it.

 

[DocVikingo]

You may feel some chest pain on the affected side, or an urge to cough, or some mild shortness of breath. Spontaneous pneumothoraces are sometimes completely asymptomatic, but often do have some symptoms.

Hi TSandM,

The OP asked: "1. What would I be feeling if a spontaneous pneumothorax was about to occur or has occurred?

Did you miss the first part and I the second?

Far as I know the patient typically would be asymptomatic when the SP was about to occur. Am I incorrect?

I agree that sumptoms such as you describe may be present once SP has occurred.

Thanks,

Doc

 

[TSandM]

Yes, DV, I was unclear. There would be no symptoms prior to the occurrence, and the symptoms I described would be present once the lung had collapsed.

 

[Dirty-Dog]

I can't add anything to what Doc and TSandM have said as far as symptoms go. However, I will say that both my wife and I have had traumatic pneumos (motorcycle crash). She had bilateral pneumos. Before we started diving, I checked with a local pulmonologist who is also a diver and he had no concerns about either of us diving.
So +1 for "I really wouldn't worry about it."

 

[Uncle Frank]

Thanks for the encouragement and don't worry - I'm not the sueing type. I will keep you posted on developments.

 

[knowone]

You may feel some chest pain on the affected side, or an urge to cough, or some mild shortness of breath. Spontaneous pneumothoraces are sometimes completely asymptomatic, but often do have some symptoms.

The danger in diving incidents is not simple pneumothorax. Absent major underlying lung disease, most people cope pretty well with a simple pneumo. (I've had patients show up in the ER where the history makes it clear that they've been walking around with a collapsed lung for several DAYS.) The danger with PTX underwater is that the air that escapes from the lung will expand while you ascend, because it can't get out anywhere. This causes what's called "tension physiology", where the expansion of one side of the chest physically pushes the heart and great vessels over to the other side, kinking the vena cavae and reducing blood return to the heart. No blood return = no blood pumped forward, and the patient goes into shock. The only field treatment for this is to relieve the pressure by making a hole in the chest wall on the affected side. Paramedics do this with a large gauge needle with a latex valve on it, so air can get out, but not back in. If you make a big hole in the chest and don't have some kind of valve on it, then when the patient tries to inhale, air just comes in the hole and not down the trachea, so this is NOT a benign intervention, and should NOT be considered by lay people who are unsure of the diagnosis and don't have correct equipment.

Honestly, your risk of pneumothorax after a simple pulmonary laceration is very low. Please don't sue me, but I really wouldn't worry about it.

How refreshingly professional and humorously a lifetime rolls off the tongue