Dangers of a Punctured Lung & its Symptoms and Treatment

Punctured lung is a serious ailment of the lungs which is generally due to some accidental and traumatic injury. The dangers of a punctured lung need to be understood to appropriately treat the condition and prevent complications.

The lung gets punctured if any sharp object penetrates into the chest cavity of the human body. The accidental injury can occur due to a pointed & sharp knife, bullet fire or gunshot wounds and rib fractures in sports injuries or accidents. Medical term for the condition is collapsed lung or pneumothorax. The word pneumothorax is a combination of two Greek terms, pneumo (air) and thorax (chest), which is because air enters the lungs due to the punctured wound.

Punctured lung can also be caused by:

• Inhaling harmful chemicals
• Treatment for an infection or while on a ventilator in a hospital.

Apart from the direct causes, indirect causes such as fat embolism, drug overdose, and severe burns which can also injure lungs.

While there are many serious causes of a punctured lung, it is also necessary to understand the dangers of a punctured lung. A lung injury can develop into two life threatening conditions viz., collapsed or punctured lung or can develop into acute respiratory distress syndrome (ARDS), both of which are dangerous.

In punctured lung, air gets accumulated between the lungs and the chest cavity. Because of excessive air pressure, the lungs are unable to expand which leads to difficulty while breathing and pain in the chest, etc. Breathing difficulty causes low oxygen saturation and the vital organs get little supply of much needed oxygen. These are the basic dangers of a punctured lung, which can lead to serious complications, if not treated in time.

When a lung injury occurs, the lung can become inflamed and there can be difficulty in keeping the lungs from filling with air and getting oxygen, thereby the respiratory system may fail entirely. This condition is called acute respiratory distress syndrome (ARDS). ARDS can cause low oxygen levels in the blood.

The assessment of punctured lungs is done by measuring size and depth of the wound and responses of the lungs to it. Symptoms of punctured lung need to be known to avoid the dangers of a punctured lung.

The symptoms and vital signs of a punctured lung include:

• Fatigue, dizzy and headache
• Coughing, which can also expel blood
• Acute pain in the chest, near injury
• Increase in chest pain during inhaling
• Breathing difficulty and shallow breathing
• Abnormal pulse and heart beat due to lack of supply of oxygen to the heart
• As the injured ruptured site is open, there remains a possibility of infection in the chest. If prompt treatment is not received, it can ultimately lead to a potential life threatening ailment, septicemia.

Important signs to be noted during clinical examination that can point towards dangers of a punctured lung include:

• Cyanosis or bluish discoloration of the lips, tongue and nails
• Low oxygen saturation and poor supply of oxygen to vital organs
• Collection of air in areas around the lungs whether in chest cavity or in pleural space

If a person experiences trauma to the chest and is awaiting medical help, some immediate steps that can help include:

• Do not panic, remain quiet and calm
• Avoid gasping or coughing
• Do not consume any liquids/fluids
• Remain or stay in upright, seated position

Diagnosis of a punctured lung includes taking history about the injury to the lungs and the person’s medical history.

• Traumatic details, nature of wound and the extent of severity to assess the possible dangers of a punctured lung.
• Assessing the vital signs and symptoms of a punctured lung to plan appropriate investigations and treatment.
• Blood tests to detect infection related to punctured lung and sputum cultures help finding causes of an infection.
• An arterial blood gas analysis shows oxygen and carbon dioxide levels in the blood.
• X-ray of the chest revealing transparent shadow of air and sharp defined edge of the lungs
• A computed tomography (CT) scan can spot detailed view of the lungs to find out underlying problems like an obstruction or other causes of a punctured lung.
• Bronchoscopy can help finding lung infections with the help of a viewing tube or, combined with biopsy, if found appropriate in case of punctured lung.

Treatment of a punctured lung mainly depends on the underlying cause and the nature of injury. The dangers of a punctured lung can be assessed and prevented depending on the extent and severity of the lung injury.

Treatment of Punctured Lung Includes:

• Supplementary oxygen that helps in absorption of air within the chest cavity and in pleural space.
• Assessment, cleaning and covering of the wound with bandage. Wound may also be potted with bandage containing petroleum jelly for prevention of entry of air in the untreated wound
• Small bore needle or tube is injected in affected areas of pleural space to remove air while other end of tube is inserted in a bottle containing water.
• Antibiotics to treat infection and control possible dangers of a punctured lung.
• Surgery may need to be considered in severe cases of punctured lung or if injury is bilateral, involving both lungs.

In the case of respiratory distress or ARDS, the person is closely treated and cared for in the intensive care unit (ICU) of a hospital. A supportive breathing technique named positive end expiratory pressure (PEEP) is generally helpful in severe conditions. The ventilator is necessary to be used for resuming normal breathing. These actions, if taken immediately can help to control the dangers of a punctured lung.

If the ventilator is required for some extra period, it is essential to place breathing tube directly into windpipe by operating a small cut in the neck (called tracheostomy).

Fluids are taken through an intravenous (IV) line or feeding tube, which are meant for providing nutrition, preventing dehydration, and improving blood flow. Medications required in ARDS may include:

• Anti-inflammatory medicine for reducing inflammation
• Diuretics for reducing building up fluid
• Inhaling of bronchodilators for opening of air passages.

In addition to the most severe ones, some dangers of a punctured lung may include certain short term conditions, which too need to be managed well. Such conditions may include shortness of breath, fatigue, weakness of muscles, depression and other related complications

Precautions can help with everyday activities and a pulmonary rehabilitation program may help returning to normal activities. For depression, help from a mental health professional and support professionals may be required. Smoking can be dangerous and hence, is avoidable. A follow-up with medical professionals for proper functioning of lung tests may be required for long term.

The development in the field of medical science and advanced system can help in betterment of treatment procedures. The research, study and outcomes are on the way in following areas for punctured lungs:

• Improvement in fluid transport in the lungs
• Altering immunization system responses that affects lung inflammation
• Changing protein levels affecting blood clotting.

After injury and medication for a punctured lung and pneumothorax, a preventative procedure named thoracotomy or also called thoracoscopy with pleurodesis may be found necessary and recommended after with the intention to prevent recurrence. The decision for recommendation depends largely on estimation of the risk of recurrence and the possible dangers of a punctured lung.