spontaneous pneumothorax

[buck8]

Back in 1992 I had a spontaneous pneumothorax caused from a bleb (a small cyst common in tall thin males) on my left lung. After some extensive surgery I was told I would be able to return to diving, since they attached my lung to my chest cavity as they do with Air Force pilots.
The question I have is that since that I have not been diving and I just had a chest xray and full physical. I recieved the ok by the doctor and would just like some more feedback from the dive doctors on this forum, or anyone that has had this proceedure done and returned to diving, regarding this matter as I am going through my refresher classes and what to do IF (even though the doctor said it should not) ever become an issue during a dive as I feel the more I know the better off I am with handling the situation and letting my buddie know what to do if this should ever occur.

 

[The Iceni]

Hi buck,

I am a little surprised noone else has contributed to your query.

I speak not as your doctor but "this is what I would do".

1) learn all you can about the causes, sequelae and treatment of a TENSION PNEUMOTHORAX.

2) Ensure you teach all your potential buddies how to recognise a pheumothorax and how to treat it, and carry a large bore needle for them to use on you just in case and make sure they are prepared to use it. If it happens on a dive you are a long, lomg way and a long, long time from professional help, which is likely to arrive too late.

3) Dive with added conservatism and with particularly slow ascents.

Take note

a) Spontaneous pheumothorax is relatively common in tall fit young men.

b) Any pneumothorax can develop into a tension pneumothorax as the torn tissue can act as a one-way flap valve allowing air to enter the chest cavity but not to escape.

c) A tension pneumothorax is potentially - and rapidly - fatal causing bilateral compression of both lungs and the mediastitinum, effectively stopping both respiration and venous return to the heart. In addition the compressed gas finds the line of least resistance to escape the chest cavity and so enters the blood stream (via the pulmonary venous system) to cause an arterial gas embolus.

d) A tension pneumothorax is easy to reverse by the means of needle thoracostomy (or chest drain).

I carry a number of 16 gauge IV cannulas in my diving kit for this very reason.

For a highly styalised example of the effects of and field treatment of a tension pneumothorax take a look at the movie "Three Kings". In the military situation of "a sucking chest wound" the skin acts as the flap valve allowing air through the chest wall into the pleural cavity but not out. With lung diseases, such as emphysema (a seen in smokers) the leak is internal as the damage is ito the alveolar walls.

If you suffer a tension pneumothorax at depth, as you ascent the relative intrathoracic pressure will rise, worsening the condition considerably. From 30 metres the intrathoracic pressure could, theoretically rise to 44 psi - greatre than the pressure of a car tyre!

Pleuradhesis is usually curative, unless the patient has underllying lung disease, such as bullous emphysema.

Diving is not without it's hazzards.

This is waht DAN have to say

A spontaneous pneumothorax can occur in an apparently healthy person with no warning. This is due to a defect in the lung which may be congenital or may have appeared later in life. The recurrence rate of this type pneumothorax is high, and for that reason these individuals are usually advised not to dive. The risk is that a spontaneous pneumothorax might occur while diving, resulting in a closed air space which could not be equalized as the diver ascends. The resulting expansion of this air space with decreasing ambient pressure would interfere with the function of the heart and the other lung, with possible disastrous consequences.

Hope this helps.

 

[buck8]

Paul,
Thank you for your reply, You pretty much answered all of my concerns as a fellow diver, and I found that my approch to this situation if it should ever arise was exactly as you have suggested which really puts my mind at ease as far as being prepared for this situation.
When this originally happened i was working as a police officer on my late night shift and just kind of blew it off until I realized that I almost couldnt breath anymore, but I still remember that sharp little pain that I had before it happened.
The only problem i have is getting a large bore needle in the states, and can I get a one way flow needle or tool if this needs to be done while still at depth to release the air but not let water into the chest cavity??
And as far as expecting a buddy to jam a needle into my chest you know how some guys are real macho to say yeah I can do that but when it comes crunch time Im pretty sure I might have to do it myself and im prepared for it lol.

Also I to am surprised it took this long for someone to reply.
But in return I have been talking with some commercial divers who have had this problem and surgery and they said their biggest fear is large surges that can change the pressure very quickly and they said as a recreational diver the most important thing will be slow ascents and no matter what take the time to make that saftey stop just to make sure your final ascent is slow enough because that is where the problem would start.
Agian thank you for you time.

Bill