Open Pnuemothorax

Sherry Lynch

Open Pneumothorax
A large defect of the chest wall causing equilibration between the interthoracic and atmospheric pressure. If the opening is 2/3 or more in diameter of the trachea, air will prefer to pass through the open chest wound.

 Open Pneumothorax can be caused by anything that can create a significant wound in the chest wall. It mostly penetrating wounds e.g. stab wounds, gun shots, explosion, MVA

Causes

Pathophysiology
During inspiration, when a negative intra-thoracic pressure is generated, air is entrained into the chest cavity not through the trachea but through the hole in the chest wall. This is because the chest wall defect is much shorter than the trachea, and hence provides less resistance to flow. Once the size of the hole is more than 0.75 times the size of the trachea, air preferentially enters through the thoracic cavity. This results in inadequate oxygenation and ventilation, and a progressive build-up of air in the pleural space. The pneumothorax may tension if a flap has been created that allows air in, but not out

Mechanics

Mechanics of a sucking chest wound. A. Air enters the chest through the opening in the chest wall during inspiration (a). The lung collapses on the affected side (b), air passes out of affected bronchus. Air enters the bronchus from the collapsed lung (c) and passes to the intact lung. The mediastinum shifts toward the uninvolved side (d), and hemothorax occurs (e). B. During expiration, air escapes through the wound (a). The collapsed lung expands (b). Air passes from the uninvolved side to the lung on involved side and out the trachea (c). The mediastinum shifts to the involved side (d), and hemothorax occurs (e).

Clinical Manifestations
Dyspnea Sudden sharp pain Subcutaneous Emphysema
Air collects in subcutaneous fat from pressure of air in pleural cavity Feels like rice crispies or bubble wrap Can be seen from neck to groin area

Decreased lung sounds on affected side

Clinical Presentation
Red Bubbles on Exhalation from wound ( a.k.a. Sucking chest wound)

Treatment
The goal is to seal the wound; therefore, use a nonporous material, if possible, such as Vasolineimpregnated gauze or adhesive tape or heavy cloth Place a chest drain Administer 100% oxygen with face mask Place the casualty in the semi-Fowler's position or any other position that is comfortable. Fowler's position that in which the head of the patient's bed is raised 1820 inches above the level, with the knees also elevated

Treatment
If he is unconscious, lay him on his injured side. Observe the casualty for signs and symptoms of shock. Give the casualty an IV with serum albumin.

References
http://mstcparamedic.pbworks.com/ Open-Pneumothorax http://www.trauma.org/archive/thora cic/CHESTopen.html