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Updated October 16, 2011

John:

John was a very popular high school student. His father and stepmother were out of town when he felt a sudden "pop" in his chest while walking to class. Within a minute, he was feeling severe pain and shortness of breath.

School Nurse:

John took a pass from his teacher and went to see the school nurse. She was familiar with John because of his popularity around school, but he'd never been to see her with a medical complaint before. The air in the California Central Valley had been bad lately, and plenty of kids were complaining of trouble breathing. She wasn't particularly surprised to see him. She listened to his lungs, but didn't hear any of the wheezing typical of asthma, the most common complaint at the school. As she assessed John, he got worse.

Symptoms:

John was sitting on the side of the little cot in the nurse's room. He leaned forward and placed his hands on his knees, breathing through his mouth. To the nurse, he looked as if he'd just finished running sprints in PE class. When he spoke, it was only one or two words between breaths - and he was complaining of pain in his chest. Although she didn't hear wheezing, John's lungs didn't sound as loud on the right side of his chest as they did on the left. She decided to call 911.

The Ambulance:

The ambulance arrived with a paramedic and an emergency medical technician (EMT). The EMT took vital signs; blood pressure, pulse, and respiratory rate. The paramedic listened to John's lungs like the nurse had done. The paramedic heard the same thing, and asked her EMT partner to give John some oxygen. The EMT said he would, and told the paramedic that John's blood pressure was low, while his pulse was rapid. After putting on the oxygen, they helped John to their gurney.

The Needle:

Once John was on the gurney, the paramedic pulled out a long, thick needle while the EMT attached a cardiac monitor to John's chest. The EMT also placed a pulse oximeter probe on John's finger. The paramedic told John not to move and prepared a spot on his chest with an iodine swab. She inserted the needle in John's chest until it struck a rib. She gently guided the needle over the bone and deeper into his chest. She smiled when she felt a small puff of air come out of the needle.

Collapsed Lung:

John's condition is known as a pneumothorax, or collapsed lung. In the worst case scenario, collapsed lungs can put pressure on the heart and large blood vessels in the middle of the chest, decreasing blood pressure and causing shock. This is called a tension pneumothorax, and requires decompression (what the paramedic did in this case) to relieve the pressure.

Collapsed lungs are relatively common injuries in car accidents, stabbings, and gunshot wounds, but John had not been involved in any trauma.

What John experienced is a spontaneous pneumothorax. This happens in teenage boys, typically with a lean, tall build, and in people with chronic lung diseases such as COPD - chronic bronchitis and emphysema. Here are some more resources to learn about breathing problems:

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