What to Do for a Collapsed Lung

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This survival-medicine website provides general information, not individual advice. Most scenarios assume the victim cannot get expert medical help. Please see the disclaimer.

What to Do for a Collapsed Lung

In this X-ray, both lungs are collapsed. The arrows point to the outside linings of the lungs. The black areas are air.

by James Hubbard, MD, MPH

I remember one patient in particular, a nurse. I was less than a year out of training. She was working on the floor when I was in the emergency room. She came up to me and said, “I think I have a collapsed lung.” She was holding the side of her chest and obviously in pain but didn’t appear short of breath.

This was a first for me—someone just coming up and self diagnosing such a thing. I asked her how she knew. She said she’d had a couple before. Ohhh. I’d read about this. If someone’s had one spontaneous collapsed lung they’re at increased risk to have another—especially among smokers, and I knew she was one of those. Their small airway walls thin out, and sometimes one can spring a leak of air into the space between the lungs and the chest wall. Voilà—collapsed lung.

Anyway, when I listened to her chest with a stethoscope, she had decreased breath sounds on the side of the chest with the pain. Her oxygen level was good, but a chest X-ray showed a small pneumothorax (partially collapsed lung). She took some anti-inflammatories and stayed off work a few days; the leak sealed over, and soon the chest X-ray (and she) was back to normal.

What Causes a Collapsed Lung

Books adA pneumothorax means air (pneumo) in the chest (thorax). This happens when air leaks into the space between your lungs and your inner chest wall.

Normally this area is what we call a “potential space” because the lungs touch the chest wall. (There’s really no space, but there could be.) When you expand your chest, your lungs keep touching the chest wall and expand also. That brings in the air we all need to breathe. If something like air or fluid gets into that potential space, it takes the place of where the lung should be. All the lung can do is reduce in size or collapse.

Reasons for a collapsed lung:

  1. A puncture from a broken rib. That’s the kind I was familiar with before the nurse.
  2. A puncture wound through the chest wall. If a knife or stick or the like punctures the chest wall, air comes pouring in from the outside.
  3. A weak spot in the lung that starts leaking. Emphysema or other smoking damage to the lungs can do this, as can asthma, pneumonia, or lung cancer. Some people are born with a little bleb, or weak spot.

These are the ones you’re going to see in the field. In a hospital setting a lung can be damaged by surgery or a procedure like a bronchoscopy (looking down into the lungs with a long, lighted tube). The added lung air-pressure of being on a ventilator can do it too.

Signs and Symptoms

Symptoms: Usually you’ll have sudden pain on the affected side of the chest, and shortness of breath.

Signs: With a stethoscope or an ear to the back of the chest, you may hear that the breath sounds are notably decreased or absent on the side of the pneumothorax.

>> Breathe easily with The Survival Doctor’s guide books—step-by-step instructions for when you’re the only help around.

The definitive treatment for a large pneumothorax (collapsed lung) is a chest tube hooked up to a device that provides constant suction so the hole has time to heal. This man has a chest tube in his right lung. It’s the tube coming from under the bandage. (Most of the other tubes are monitor wires.)

Treatment

If there’s a puncture wound through the chest wall, you’ll need to seal it with something like petroleum jelly and a bandage.

Until you can get to a medical facility you’re just going to have to decrease your activities (thereby decreasing your need for extra oxygen) and take whatever you have for pain. Many leaks heal on their own.

If there is severe shortness of breath and you’re not going to be able to get expert help, as a last resort, you can stick a hollow 18- or 20-gauge needle (with a syringe on it) over the top of one of the ribs in the area where there are no breath sounds (in the back or side of the chest). The reason it should be just over the top is a nerve, artery, and vein run underneath each rib, and you don’t want to hit those.

The needle is going to need to be one-and-a-half inches, or longer, to get into the chest cavity. As you go in, pull back on the syringe. You’ll know you’re in the right place if you start pulling back air. Don’t go further or you could stick the lung and make it worse. Also there’s always the risk for infection. In other words, like most medical procedures, this can be dangerous. Only do it as a last resort in someone who looks like they’re not going to last long enough to get expert medical care.

But, if there’s a large pneumothorax (and that’s usually the case if there’s severe shortness of breath), the definitive treatment is inserting a chest tube hooked up to a device applying constant suction for several hours to a few days, to give the leak time to heal. Unless you have this in your medical kit (and some people do) you’re going to have to suck as much air out as you can with the needle and syringe until the person is breathing better or you can get help. Use a 10cc or even 50cc syringe if you have it so you’ll only need to stick it in once or twice. Of course some holes never heal without surgery.

Caution

One other thing. You can get something called a tension pneumonthorax. Instead of the air pressure equalizing, the leak becomes a one-way valve. It pushes air in, but the air cannot escape. This puts enough pressure on the heart and other lung that it becomes a true emergency. The blood pressure drops and the pulse increases. Often the person becomes less alert and may lose consciousness. The heart may even stop. The treatment is relieving the pressure immediately. More on that in another post.

 

Have any of you ever had a collapsed lung? How did it happen? What were your symptoms? How was it treated?

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X-ray courtesy Morgan Le Guen, Catherine Beigelman, Belaid Bouhemad, Yang Wenjïe, Frederic Marmion [CC-BY-2.0], via Wikimedia Commons. Collapsed-lung patient photo by Kairuuinzuro on Flickr.

  • Elizabeth

    my friend has just gone into the hospital for a collapsed lung and I wnt to throw together a little gift basket for her. I was wondering if there was anything I should avoid or, on the contrary, anything that would help her feel a bit better? ex/ drinks food etc.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Just what they’d usually enjoy. Chocolate?

  • Carol Ambrose Lane

    Ok. Friend of mine a Dentist in Canada had a cold. Lung collapsed went to Dr wasn’t sure what was wrong. X-Ray ER now has a tube BP Spiked 12 hour observation in hospital. So guessing Antibiotic to clear lungs. You say Antinflammatory? Guess not understanding the significance of the cold? Could you please explain, how a chest cold could cause a lung to collapse?
    Thank YOU!!

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Carol, a cold is an upper respiratory infection which means the infection doesn’t include the lung (which is in the lower respiratory tract) so unless he coughed so much the pressure caused the lung to leak (and I’ve never seen that although I know it can happen with whooping cough), then I don’t know. Maybe the cold developed into pneumonia. Or he could have had a spontaneous pneumothorax which happens when the lung just starts leaking all of a sudden, from from weak spot–either from birth, from smoking or emphysema, or some other chronic lung problem.

  • Bill

    Hi Dr. Hubbard; I had a collapsed lung last June from broken ribs in a motorcycle accident. I spent 4 days in the hospital with a chest tube. Sometime after discharge from the hospital, my lung partially collapsed as evident by CT scan. This was last Octobeer/ November timeframe. I have an appointment with a pulmanologist next week. My main complaint now is shortness of breath to the point I have trouble with stairs or walking at a fast clip. I am using symbocort, combivent inhalers and Lukmoskat pills (something like that) and am marginally better based on activity and spirometer. What could I expect the treatment to be? I desire strongly to be in the pre accident health condition

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Bill, a few reasons you could be short of breath are wheezing, the lung hasn’t fully extended, or you physical conditioning. Until you get the first two treated well, it would be difficult to address the third one. Make sure to ask the pulmonologist what he thinks about an exercise program. Also, you might ask about breathing exercises such as the ones listed here under #2 http://www.thesurvivaldoctor.com/2012/05/03/asthma-attack-without-inhaler-9/

  • Alex

    Can you help me with something? I had recently gone through a collapsed lung and my friend decides that the best course of action, if or when it happens again, would be to stick a “metal straw” in my chest cavity and provide mouth-to-mouth. I’ve been telling them that this sounds like a really bad idea, but they won’t listen to me. I have a few ideas why and was wondering if you could tell me if they’re valid:

    1) Stabbing a “metal straw” in my chest now makes a gaping hole in my side with nothing stopping more air from filling the area between the lung and the chest cavity.
    2) As far as I know, they’ve had no training in mouth-to-mouth whatsoever and I’ve heard that mouth-to-mouth isn’t as effective as most people believe.
    3) Stabbing some random “metal straw” into my chest can lead to infection so I now have three problems to worry about.
    4) They have no way of knowing how much my lung is collapsed so they could stab it in my chest and puncture my lung, so that now makes four problems I have, three of them being quite severe.
    I just wanted your professional input so I can explain to them why it’s a bad idea. If it’s not a bad idea, now I have some tips in case it happens again. Thank you!

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      That’s a horrible idea for all the reasons you mentioned.

  • GLYNDMD

    You can suffer several recurrences with Catamenial Pneumothorax. Women are being diagnosed in record numbers. Also many with Catamenial Hemoptysis.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Thanks, GLYNDMD, Catamenial meaning related to menstrual period. My understanding is the reason for these are unknown, and it’s a pretty rare reason (about 6-8 percent) for a pneumonthorax in women, but many have to go to surgery to prevent recurrences.

  • Marissa Peterson

    For the needle decompression, would a sterile hollow point piercing needle work?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Yes, but they don’t have a hub at the end to stop them from going in all the way. So I am extremely concerned someone might push them in too far and not be able to get them out.

      • Marissa Peterson

        Ok, thanks!

  • Marissa Peterson

    Could you post a photo of where to insert the needle? I would like to be sure, just in case!

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      I’ll try to do that, but it’ll be about a week. Thanks.

      • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

        Actually I found a photo here http://bit.ly/16cw9nd
        But it is going be rare that you’d ever have to do that in the field. If I were to see someone extremely short of breath with no breath sounds on one side, I’d think of tension pneumothorax first and try to decompress it immediately. For that, you’d need a long needle (16 to 14 gauge) and stick it, on the side of the decreased breath sounds, above the third rib about an inch or two from the sternum. I’ll have a video on that in a new dvd I’ll have out in a couple of months.

        • Marissa Peterson

          Thanks!

          • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

            You’re welome.

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  • Aloha808

    - Im 16 and I had a collapsed lung when i was a baby in 1996 pretty much close to a new born baby . I’m not sure what would have cause this because i was still a little baby and they said i wouldnt survive but thanks to my mom and the man above us didnt give up on me (: . BUT , i was wondering .. will it be okay that ive had surgery a long time ago . . . .and in the future if i get pregnant will it affect me or my lungs , my breathing ? .

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      That would be something to ask your doctor, but if your lungs are ok now, I would see no reason why surgery on them would affect anything. Oh, just the same, don’t smoke.

  • Erik

    Recovery is the most painful. The procedure itself isn’t so much. I have a collapsed lung now and am in recovery. It was caused from heavy cigarette smoking. When it collapsed I felt like I was having a heart attack. The pain was in my chest and between my shoulder blades.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Thanks for sharing your experience Erik.