RT Book, Section
A1 Reichman, Eric F.
A2 Reichman, Eric F.
SR Print(0)
ID 1159797369
T1 Open Chest Wound Management
T2 Reichman's Emergency Medicine Procedures, 3e
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259861925
LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1159797369
RD 2024/04/24
AB Open  chest  wounds  come  in  a  variety  of  shapes  and  sizes.  Their  one  commonality  is  an  open  communication  between  the  pleural  space  and  the  external  environment.  The  wounds  have  often  been  sealed  by  the  soft  tissues  of  the  chest  wall  in  the  vast  majority  of  patients  with  penetrating  injuries  to  the  chest.  The  primary  concern  with  these  patients  is  the  diagnosis  and  treatment  of  underlying  thoracic,  cervical,  and/or  abdominal  injuries.  Rarely,  small  perforations  may  produce  a  valve-like  entry  into  the  pleural  space,  enabling  air  to  be  “sucked  in”  during  inspiration  but  blocking  air  egress  during  expiration.1-3  Thus  air  will  continue  to  accumulate,  leading  to  a  tension  pneumothorax  requiring  needle  decompression  followed  by  a  tube  thoracostomy.  Larger,  more  destructive  wounds  of  the  chest  may  also  occur.  These  are  most  common  in  combat  injuries.  In  civilian  practice,  they  are  often  secondary  to  shotgun  injuries.  The  larger  wounds  are  also  caused  by  high-velocity  weapons,  explosions,  on-the-job  injuries,  propeller  injuries,  or  fencepost  impalements,  to  name  a  few.  Clothing,  wadding,  shell  fragments,  and  pieces  of  the  chest  wall  may  all  be  driven  into  the  thoracic  cavity.  Such  injuries  are  associated  with  physical  loss  of  a  portion  of  the  chest  wall  itself,  making  adequate  ventilation  impossible.4,5