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Open Pneumothorax

Page history last edited by PBworks 12 years, 4 months ago

 What is Open Pneumothorax?

Open Pneumothorax is a disruption in the chest wall that leads air to move freely between the atmosphere and the pleural space.  Air is drawn into the wound as the chest moves outward and the diaphragm moves downward during inspiration. The internal thoracic pressure drops and air rushes through the wound and into the chest cavity. This air replaces the lung tissue and permits lung collapse and results in a large functional dead space.  On exhalation, the contracting chest wall and the rising diaphragm increase the internal pressure and force air outward through the wound. This movement of air into and out of the chest through the wound is the cause of a "sucking" sound that leads to the wounds common name, "sucking chest wound".

 

 

Causes

Open Pneumothorax can be caused by anything that can create a significant wound in the chest wall.  For air movement to occur through the opening in the chest wall, the opening must be at least two thirds the diameter of the trachea.

 

Signs and Symptoms

  • Penetrating chest trauma
  • Sucking chest wound
  • Frothy blood at wound site
  • Dyspnea
  • Hypovolemia

 

Treatment

Support the patient with open pneumothorax by administering high-flow, high concentration oxygen, and monitoring oxygen saturation and respiratory effort.  If you find a penetrating injury, cover it with a sterile occlusive dressing taped on three side.  This converts the open pneumothorax into a closed pneumothorax, prevents further aspiration of air, and relieves any building pressure (tension Pneumothorax) through the valve like dressing.  If dyspnea diminishes somewhat but still continues, provide positive pressure ventilations and intubate as indicated. 

 

If the patient has progressive breathing difficulty, appears to be hypoventilating and hypoxemic, decreased breath sounds on injured side, and increasing jugular distension, remove the occlusive dressing.  If you hear air rush out and patients respirations improve, reseal the wound, monitor breathing, and again remove dressing if any respiratory signs or symptoms redevelop.  If removing the dressing does not relieve the increased signs and symptoms, suspect and treat for tension pneumothorax. 

 

Reference: Paramedic Care Principles and Practice, Volume 4 Trauma Emergencies Pgs. 400-401 and 418-419

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