11 Mar Cocaine Use and Barotrauma
Barotrauma is a general term used to describe tissue damage caused by abnormal pressure in the body that makes air accumulate in places where it does not belong. Areas particularly susceptible to this type of damage include the ears, sinuses, and lungs. People who use cocaine have significant risks for the development of several different types of lung-related barotrauma, including ailments called pneumothorax (lung collapse), pneumomediastinum, and subcutaneous emphysema. They also have unusual risks for the development of a form of heart-related barotrauma called pneumopericardium. Most of these risks are associated with cocaine smoking, although users of intravenous (IV) cocaine may also develop a pneumothorax.
Pneumothorax is a term doctors use to describe the accumulation of air in the space that sits around the lungs. This air “collapses” the affected lung by placing too much pressure on it for the organ to inflate properly during breathing. Symptoms of a relatively small pneumothorax typically include unexplained shortness of breath and acute chest pain that grows worse with coughing or an attempt to take a deep breath. Symptoms of a more extensive pneumothorax commonly include unexplained chest tightness, an accelerated heartbeat, an unusual susceptibility to fatigue and the development of a bluish tinge to the skin (this last symptom is a consequence of oxygen deprivation). Potential consequences of a lung collapse include future lung collapses and development of shock, a potentially fatal condition characterized by dangerously low blood pressure.
Pneumomediastenum gets its name from the mediastinum, which is the space between the lungs in the center of the chest. People develop this condition when air accumulates abnormally within the mediastinal space. Apart from cocaine use, problems that can produce the pressure changes required to trigger this accumulation include vomiting, heavy and/or recurrent coughing, sneezing, and strong, purposeful contraction of the abdominal muscles. Compared to a pneumothorax, pneumomediastinum is relatively rare in the general population. Many people with the condition have no obvious symptoms. When symptoms do occur, they typically manifest as pain beneath the sternum (breastbone) that may or may not radiate outward into the arms or neck.
Subcutaneous Emphysema Basics
Subcutaneous emphysema occurs when air pockets form abnormally in skin located in the chest or neck, or (less commonly) in various other locations. The primary visual sign of this condition is the formation of skin bulges that have a smooth, regular appearance. When these bulges are touched, they emit a crackling sound that indicates the passage of the trapped air as it makes its way through the surrounding tissue. Doctors take the presence of subcutaneous emphysema very seriously, because it usually indicates the presence of pneumothorax or some other potentially severe underlying medical condition, the US National Library of Medicine explains.
Pneumopericardium occurs when air accumulates inside the pericardial cavity, a space that sits between the heart’s outer layer and a surrounding sac called the pericardium; this sac helps protect the heart from infection, and also serves additional purposes that include limiting the heart’s outward expansion and keeping the heart in a secure position inside the mediastinal space. When introduced quickly, even relatively small amounts of air can significantly alter normal heart function. Doctors detect pneumopericardium by listening for certain distinct changes in the sound the heart makes during examination with a stethoscope.
As indicated previously, people who smoke crack cocaine develop pneumothorax, pneumomediastenum, subcutaneous emphysema, and pneumopericardium relatively frequently. These problems don’t stem from any drug effects related to cocaine use, according to a comprehensive study review published in 2007 in the Radiological Society journal RadioGraphics. Instead, they come from pressure increases in the lungs associated with the physical act of smoking crack. In some cases, the increase in pressure comes from coughing fits that occur when crack smoke enters the lungs’ interiors. In other cases, it comes from a specific form of inhalation that crack users learn in order to draw the drug rapidly into the lungs’ deeper recesses. It can also come from a two-person technique of crack inhalation that requires one user to literally blow crack smoke deeper into the lungs of the other user.
IV cocaine users also sometimes develop a collapsed lung. Typically, the process behind such a collapse begins when a long-term user loses the ability to easily inject the drug into common veins of access, such as those located in the crook of the elbow. In this situation, some people try to inject cocaine into neck veins such as the subclavian vein or the interior jugular vein, the authors of the study in RadioGraphics report. Any attempt to access these veins can lead to an accidental laceration of the very top of one of the lungs; in turn, it is this laceration that encourages the onset of pneumothorax.
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