A pneumothorax (noo-mo-THOR-acks) is a collapsed lung. Pneumothorax occurs when air
leaks into the space between your lungs and chest wall. This air pushes on the outside o your
lung and makes it collapse. !n most cases" only a portion o the lung collapses.
# pneumothorax can be caused by a blunt or penetrating chest in$ury" certain medical
procedures in%ol%ing your lungs" or damage rom underlying lung disease. Or it may occur
or no ob%ious reason. &ymptoms usually include sudden chest pain and shortness o breath.
The lungs normally inlate by increasing the si'e o the chest ca%ity" resulting in a negati%e
(%acuum) pressure in the pleural space (the area within the chest ca%ity but outside the lungs).
! air enters the pleural space either by a hole in the lung or the chest wall" the pressure in the
pleural space e(uals the pressure outside the body. Thus" the %acuum is lost and the lung
&pontaneous pneumothorax is caused by a rupture o a cyst or a small sac (bleb) on the
surace o the lung. Pneumothorax may also occur ollowing an in$ury to the chest wall such
as a ractured rib" any penetrating in$ury (gun shot or stabbing)" surgical in%asion o the chest"
or may be deliberately induced in order to collapse the lung. # pneumothorax can also
de%elop as a result o underlying lung diseases" including cystic ibrosis" chronic obstructi%e
pulmonary disease ()OP*)" lung cancer" asthma" and inections o the lungs.
Pneumothorax can be caused by+
• Chest injuries. #ny blunt or penetrating in$ury to your chest can cause lung collapse.
&ome in$uries may happen during physical assaults or car crashes" while others may
inad%ertently occur during medical procedures that in%ol%e the insertion o a needle
into the chest.
• Underlying lung diseases. *amaged lung tissue is more likely to collapse. ,ung
damage can be caused by many types o underlying diseases" including chronic
obstructi%e pulmonary disease ()OP*)" cystic ibrosis and pneumonia.
• Ruptured air blisters. &mall air blisters (blebs) can de%elop on the top o your lung.
-hile not considered to be a disease o the lungs" these blebs sometimes burst .
allowing air to leak into the space that surrounds the lungs.
• Mehanial !entilation. # se%ere type o pneumothorax can occur in people who
need mechanical assistance to breathe. The %entilator can create an imbalance o air
pressure within the chest. The lung may collapse completely and the heart may be
s(uee'ed to the point that it can/t work properly.
&pontaneous pneumothorax aects about 0"111 persons each year in the 2.&. who ha%e no
history o lung disease. This type o pneumothorax is most common in men between the ages
o 31 and 41" particularly in tall" thin men. &moking has been shown to increase the risk or
spontaneous pneumothorax.
Risk actors or pneumothorax include+
• %our sex. !n general" men are ar more likely to ha%e a pneumothorax than are
• Smo&ing. The risk increases with the length o time and the number o cigarettes
smoked" e%en without emphysema.
• Age. The type o pneumothorax caused by ruptured air blisters is most likely to occur
in people between 31 and 41 years old" especially i the person is a %ery tall and
underweight man.
• 'enetis. )ertain types o pneumothorax appear to run in amilies.
• (ung disease. Ha%ing an underlying lung disease . especially chronic obstructi%e
pulmonary disease ()OP*) . makes a collapsed lung more likely.
• Mehanial !entilation. People who need mechanical %entilation to assist their
breathing are at higher risk o pneumothorax.
• A history o) pneumothorax. #nyone who has had one pneumothorax is at increased
risk o another" usually within one to two years o the irst episode.
&ymptoms o a pneumothorax include chest pain that usually has a sudden onset. The pain is
sharp and may lead to eelings o tightness in the chest. &hortness o breath" rapid heart rate"
rapid breathing" cough" and atigue are other symptoms o pneumothorax. The skin may
de%elop a bluish color (termed cyanosis) due to decreases in blood oxygen le%els
# small" uncomplicated pneumothorax may (uickly heal on its own. -hen the pneumothorax
is larger" doctors usually insert a lexible tube or needle between your ribs to remo%e the
excess air.
# pneumothorax is generally diagnosed using a chest 5-ray. !n some cases" computeri'ed
tomography ()T) scan may be needed to pro%ide more detailed images. )T scanners combine
5-ray images taken rom many dierent directions to produce cross-sectional %iews o
internal structures.
The goal in treating a pneumothorax is to relie%e the pressure on your lung" allowing it to re-
expand" and to pre%ent recurrences. The best method or achie%ing this depends on the
se%erity o the lung collapse and sometimes on your o%erall health.
! only a small portion o your lung is collapsed" your doctor may simply monitor your
condition with a series o chest 5-rays until the air is completely absorbed and your lung has
re-expanded. 6ormally this takes a week or two. &upplemental oxygen can speed the
absorption process.
Needle or hest tube insertion
! a larger area o your lung has collapsed" it/s likely that a needle or chest tube will be used to
remo%e the air. The hollow needle or tube is inserted between the ribs into the air-illed space
that is pressing on the collapsed lung. -ith the needle" a syringe is attached so that the doctor
can pull out the excess air . $ust like a syringe is used to pull blood rom a %ein. )hest tubes
are oten attached to a suction de%ice that continuously remo%es air rom the chest ca%ity.
! a chest tube doesn/t resol%e your problem" surgery may be necessary to close the air leak.
!n most cases" the surgery can be perormed through small incisions" using a tiny iber-optic
camera and narrow" long-handled surgical tools. The surgeon will look or the leaking bleb
and sew it closed. !n some cases" a substance like talc may be blown in through the tube to
irritate the tissues around the lung so that they/ll stick together and seal any leaks. Rarely" the
surgeon will ha%e to make a larger incision between the ribs to get better access to multiple or
larger air leaks.
T7 is a inection disease that caused o mycobacterium tuberculosis. The spots o T7
inection germ are respiratory tracts" absorption tracts and opened in$ury in skin. 8ost o T7
inection occur pass through air " by means o droplet inhalation that consist o basil which
come rom person who inected. The spreading capacity rom a suerer is depended on the
number o germ that issued rom the lung.someone might be inected by T7 rom the droplet
concentration in the air" and how long they breath that air.
T7 is a disease that controlled by imunity response inse(uenced cell. 9ector cells are
macroag and limosit ( usually T cell ). They are imunoresponsi%e cells. This type usually
local" in%ol%ing macroag which acti%ed in inection spot by limosit and it:s limokin. The
response is called as hypersensiti%ity cellular reaction ( slow reaction )
.. +rimary #,C
it:s happen when someone attack primarly by T7) germ. The inection started when
the T7) germ replicated successully in the lung. That:s cause the inlammation. ,ime
tractus will carry T7) germ into lime gland around lung hilus and it.s called as primary
Time between inection happens until primary complexs orm are around 4 ; < weeks.
The inection cold be pro%en by by the occur o tuberculin reaction that changes rom
negati%e into positi%e. The incubation period is time needed rom inected till become
sick" approximated or about < month.
/. A)ter +rimary #,C
2sually happen ater se%eral month or year. #ter primary inection" or example
because o the descent body deense in conse(uence inected by H!= or malnutrient
status. The main characteristic or ater primary T7) is the broadening lung damage in
occurring ca%ity or pleural eusion.
+rimary +rogressi!e #uberulosis
#cti%e tuberculosis de%elops in only >? to @1? o persons exposed to M tuberculosis. -hen
a patient progresses to acti%e tuberculosis" early signs and symptoms are oten nonspeciic.
8aniestations oten include progressi%e atigue" malaise" weight loss" and a low-grade e%er
accompanied by chills and night sweats.
-asting" a classic eature o tuberculosis" is due to
the lack o appetite and the altered metabolism associated with the inlammatory and immune
responses. -asting in%ol%es the loss o both at and lean tissueA the decreased muscle mass
contributes to the atigue.
Cinger clubbing" a late sign o poor oxygenation" may occurA
howe%er" it does not indicate the extent o disease.
# cough e%entually de%elops in most
patients. #lthough the cough may initially be nonproducti%e" it ad%ances to a producti%e
cough o purulent sputum. The sputum may also be streaked with blood. Hemoptysis can be
due to destruction o a patent %essel located in the wall o the ca%ity" the rupture o a dilated
%essel in a ca%ity" or the ormation o an aspergilloma in an old ca%ity. The inlamed
parenchyma may cause pleuritic chest pain. 9xtensi%e disease may lead to dyspnea or
orthopnea because the increased interstitial %olume leads to a decrease in lung diusion
capacity. #lthough many patients with acti%e disease ha%e ew physical indings" rales may
be detected o%er in%ol%ed areas during inspiration" particularly ater a cough. Hematologic
studies might re%eal anemia" which is the cause o the weakness and atigue. ,eukocytosis
may also occur because o the large increase in the number o leukocytes" or white blood
cells" in response to the inection.
The risk actor are +
@. must ha%e inection sorce
3. the number o bacillus as an inection cause must be suicient
B. the high %irulence o T7) bacillus
4. The descent o body deense make the bacillus reproduce
)linic illustration +
@. The main symptom
)ontinous cough withEwithout sputum during B weeks or more
3. #dditional symptom
- &putum mixed with blood
- Haemoptoe
- *yspnea and chest pain
- -eakness
- 6ight sweat
- *ecrease weight
- Ce%erish e%er more than @ month
,ung T7) diagnosis can be stood at by 7T# inding in sputum inspection microscopicly. The
inspection result tangibled positi%e i at least 3 rom B &P& specimen must be positi%e.
! only @ specimen which positi%e" so it:s needed a urther check up" that is chest x-ray photo
or &P& sputum check up repeated.
a. ! the x-ray result supports T7)" so the patient is diagnosed as T7) 7T# suerer
b. ! the x-ray result unsupports T7)" so the sputum check up repeated
! three sputum specimen are negati%e" gi%e an extensi%e spectrum antibiotic during @-3
weeks. ! the condition still bad" do &P& sputum check up repeated.
a. ! the &P& result are positi%e" diagnosed as inection T7) 7T# inected
b. ! the &P& result are still negati%e" do thr chest 5-ray check up.
• ! the 5-ray result supports T7)" diagnosed as negati%e 7T# patient but the
5-ray positi%e
• ! the 5-ray result not supports T7)" the patient is not T7).
Purpose +
@. )ure the patient
3. Pre%ent death
B. Pre%ent relapse
4. *ecreasing the le%el o spreading
Category . 0/-R1E23-4R45 6
• 6ew patient lung T7) positi%e 7T#
• Patient lung T7) negati%e 7T#" 5-ray positi%e who got serious illness
• Patient hea%y extra lung T7)
!ntensi%e stage consist o !soniasid(H)" Riampicin(R)" Pira'inamid(F)" dan 9tambutol(9).
Those medicine are gi%en e%eryday during two (3) month (3HRF9). Then continued by next
stage" that consists o !soniasid(H)" and Riampicin(R). Gi%en three times a week during our
month (4HBRB).
Category / 0/-R1ES2-R1E27-4R4E45 6
• Relaps patient
• Cailure patient
• #ter deault patient
!ntensi%e stage are gi%en or three month consists o HRF9& during 3 month gi%en
e%eryday (3HRF9&)" continued by HRF9 during @ month gi%en e%ery day (HRF9). Then
continued by next stage that consists o HR9 during > month gi%en B times a week.
Category 4 0/-R1ES23-4R45 6
• 6ew patient 7T# negati%e and 5-ray positi%e" light ill.
• Patient extra light lung" it is T7) limadenitis" pleuritis eksudati%a unilateral" skin
T7)" bone T7) (except backbone)" $oint T7) and adrenal gland.
!ntensi%e stage consist o HRF" gi%en e%eryday during 3 month(3HRF)" continued by se(uel
stage that consist o HR during 4 month gi%en B times a week(4HBRB). One packet o
)ombipac B
category contents o @@4 daily blister that consist o <1 blister HRF or the
intensi%e stage and >4 blister HR or the se(uel stage each packed in a small doss and
bounded in a big doss.
Implied $A# 0-R1E5
! the end o intensi%e treatment o new patient 7T# positi%e in @
category or patient 7T#
positi%e retreatment by category 3
" sputum check up result still 7T# positi%e (positi%e
7T#)" gi%en medical implied (HRF9) e%eryday during @ month.
-ithout treatment" tuberculosis can be atal. 2ntreated acti%e disease typically aects your
lungs" but it can spread to other parts o the body through your bloodstream. 9xamples
• ,ones. &pinal pain and $oint destruction may result rom T7 that inects your bones. !n
many cases" the ribs are aected.
• ,rain. Tuberculosis in your brain can cause meningitis" a sometimes atal swelling o the
membranes that co%er your brain and spinal cord.
• (i!er or &idneys. Hour li%er and kidneys help ilter waste and impurities rom your
bloodstream. These unctions become impaired i the li%er or kidneys are aected by
• -eart. Tuberculosis can inect the tissues that surround your heart" causing inlammation
and luid collections that may interere with your heart/s ability to pump eecti%ely. This
condition" called cardiac tamponade" can be atal.