Open Pneumothorax
(The Sucking Chest Wound)
DEFINITION
Large defects of the chest wall that remain open result in a sucking
chest wound, which rapidly impairs ventilation and oxygenation
resulting in death.
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INCIDENCE
Seen in thoracic trauma victims.
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AETIOLOGY
Traumatic
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BIOLOGICAL BEHAVIOUR
Pathophysiology
Equilibration of atmospheric and intrathoracic pressure is
immediate.
If the chest wall opening is ~2/3 size of the trachea, air will
enter though it (less resistance) rather than the trachea
--> rapid hypoxia and hypercarbia.
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MANIFESTATIONS
Open sucking chest wound
Severe respiratory distress / respiratory failure and accompanying
features.
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INVESTIGATIONS
Clinical diagnosis.
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MANAGEMENT
1. Promptly close over the defect
- use a sterile occlusive dressing, large enough to overlap the
wound edges.
- firmly tape it down on 3 sides
- this creates a flutter-valve effect: while breathing in the
dressing occludes the wound; while breathing out air can escape from
the free dressing edge.
2. Place a chest tube as quickly as
possible.
- this prevents tension pneumothorax.
3. Definitive surgical closure is
frequently required.
If injury involves significant tissue loss, then operative
treatment as quickly as possible.
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