Open pneumothorax

Outlined by gunshot wounds or injuries caused sharp chest wound defect, pleural cavity and the outside world directly atmospheric transport, With the breathing air can freely pleural cavity, the open pneumothorax. Side chest injury pressure to atmospheric pressure, pulmonary pressure shrinked, spiritless subsidence depends on the extent of lung compliance and availability of pleural adhesions. Contralateral pleural cavity at negative pressure, below the injury side, mediastinal shift to the healthy side, the contralateral lung There is also a certain degree of subsidence wilt. Moreover, due to the healthy side with pleural pressure still breathing cycle changes, thus the cause of mediastinal swing (or flutter) and the residual gas convection (or swing gas), and lead to serious ventilation, ventilation dysfunction. Mediastinal swing caused heart and great vessels between distortion and damage to the chest negative pressure, venous reflux blocked, cardiac output reduction. Swing can mediastinal and hilar and mediastinal stimulate nerve plexus, causing or aggravating shock (known as shock lung pleura). Also, keep cold air from the outside pleural cavity, which will not only stimulate the pleura nerve slightly, but also a large number of body temperature and fluid loss. may or foreign body into the bacteria, increasing the chances of infection. Accompanied by chest visceral injury or bleeding, was more aggravating. Open chest wound (suck the wound) larger, caused by the respiratory and circulatory dysfunction more serious. When tracheal diameter greater than wound, if not promptly shut, and often rapidly fatal. Some penetrating chest injuries, while the air at the time of injury from the outside world into the pleural cavity, but then quickly wound closure, pleural cavity isolated from the outside world, the formation of pneumothorax is not considered open pneumothorax. Clinical manifestations of open pneumothorax patients often quickly after the injury serious breathing difficulties, fear, thin and fragile pulse frequency, cyanosis and shock. Check chest wall can be seen obviously leads to the chest wound and could hear the breath out of the air with the "hiss - hiss" sound. Side injury spontaneous delivery drum sound, breath sounds disappear, can sometimes hear the voice of mediastinal swing. Treatment of open pneumothorax easy to diagnose, once discovered, the need for the immediate first aid. According to the patient wherever they live in conditions of mutual self-help or rescue, quickly closed chest wound. Variable open to closed pneumothorax pneumothorax. Large kits available, the multi-storey block clean cloth or gauze pad thick, deep breath wounded in the end wound dressing materials and bandaging fixed. For large forest where sterile gauze or plastic sheeting will be more sharing. Require the closure dressing thick enough to prevent leakage, but not to wound within packing; Should be more than 5 cm margins above; bandaging solid fixation. Injured in transit to pay close attention to any loosening dressing and spondylolisthesis, could not be replaced, alert and tension pneumothorax occurred. Patients first arrived at the hospital after giving blood, and rehydration therapy, such as oxygen, correct breathing and circulatory disorders, Meanwhile further examination and ascertain injury. To improve the general situation, as soon as tracheal intubation under anesthesia for debridement and placement thoracic drainage. Debridement should thoroughly, but also kept health organizations, pleural cavity closure to close. If the chest wall defect is too large, can be transferred and the transfer flap flap to repair. If the lung and bronchus, such as cardiac and vascular thoracic viscera of serious injury, as soon as possible to deal with exploratory thoracotomy.