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Therapy of Pneumothorax

 The most common reason for making a thorax drainage is pneumothorax. As a result of severe thorax traumata often the inner pleura layer is dammaged by a fractured rib and this leads to pneumothorax, or air enters between the two layers of the pleura. This is a life threatening situation, because air in the pleural sack leads to compresion of the injured lung, or lungs and the heart itself. 

First aid for pneumothorax is the thorax drainage.There are two most common types of thorax drainages:

- drainage of Bülau, 

The "Bülau-Drain" is based on the Bülau principle and creates a permanent passive suction within a closed system that is based on the Heber-Drain principle. The pulmonologist Gotthard Bülau (1835-1900) used this system in 1875 for the first time for the treatment of pleural empyema.

The Bülau-drain has one significant advantage: it is relatively simple in non-clinical conditions, but it is not very effective, because of the entering point of the drain. Usually it is positioned in the lower chest.

Immagine you have a bottle halve full with water and halve full with air. If you try to lead a pipe from the lower side to the part full with air, you would never manage to pull the air out of the bottle. The same is with the pleural sack.

Another option is the Monaldi-drain. As I mentioned in my book "The Most Common Mistakes in Medical Science" by Tanya Guleria. Monaldi-Drain is laid in second or third intercostal place on the upper front chest and it functions perfectly by pneumothorax. Monaldi- Drain has smaller lumen, nevertheless it is the better option for acute pneumothorax.

Unfortunately young surgeons are not taught of this small but significant fact. Thats why in acute situations they lay the drainage by the technique of Bülau.


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