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.

top D I A B M I M P home


INCIDENCE
Seen in thoracic trauma victims.

top D I A B M I M P home


AETIOLOGY
Traumatic

top D I A B M I M P home


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.
top D I A B M I M P home


MANIFESTATIONS

Open sucking chest wound
Severe respiratory distress / respiratory failure and accompanying features.

top D I A B M I M P home


INVESTIGATIONS
Clinical diagnosis.
top D I A B M I M P home


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.
top D I A B M I M P home