II. Pathophysiology

  1. Chest wall defect >2/3 tracheal diameter shunts air via chest defect instead of via trachea
  2. Results in a failure of respiratory dynamics and secondary Hypoxia and hypercarbia

III. Symptoms

  1. History of Penetrating Trauma to chest
  2. See Pneumothorax

IV. Signs

  1. See Pneumothorax
  2. Large defect or Penetrating Trauma to chest wall

V. Management

  1. Apply a sterile Occlusive Dressing to wound
    1. Tape dressing on 3 of the 4 sides (Valve effect)
    2. Offers only temporary stabilization until Chest Tube can be placed
    3. Chest Tube is the primary management for an open chest wound
    4. Do not completely occlude the wound until Chest Tube is in place (Tension Pneumothorax risk)
  2. Place Chest Tube remote from open wound
    1. Typical Chest Tube placement is over the 5th rib in the mid-axillary line
    2. Do not use the wound site for insertion of Chest Tube (contamination risk)
  3. Surgical Consultation
    1. Provides definitive chest wound closure

VI. References

  1. (2012) ATLS 9th ed, American College of Surgeons, Committee on Trauma, p. 96-9

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