Open Pneumothorax

Also known as a “sucking” chest wound, an open pneumothorax usually results from penetrating chest trauma and creates an air passage from the environment into the thoracic cavity. Depending on the size of the wound, air can become preferentially entrained into the pleural space, causing ipsilateral lung collapse. If air can enter the thoracic cavity but is prevented from exiting (by tissue valve effect) a tension pneumothorax can rapidly develop.

 

Clinical signs

 

• Usually clinically obvious
  • Bubbling/sucking from a penetrating chest wound
• Associated respiratory distress, tachypnoea, hypoxia
• Decreased breath sounds on affected side, signs of tension pneumothorax

 

Management

 

• Oxygen to maintain saturations >92%
• Place an occlusive dressing over the wound

Traditionally a 3 -sided flutter dressing was advocated, but a recent review by the UK NICE team have shown there is no evidence for this practise¹

• If indicated, place a tube thoracostomy through a new incision

 

 

 

Disposition – interhospital transfer guidelines

 

 

References

 

1. Major trauma: assessment and initial management. NICE guideline. Published: 17 February 2017 nice.org.uk/guidance/ng39