Open pneumothorax

there is the introduction part of the torso trauma,
check out my next ppts for further more about torso trauma.
contents are in following order...
introduction
mechanism of injury
junctional zones of torso
tension pneumothorax
cardiac temponade
massive hemothorax
etc.
check out all slides

1. OPEN PNEUMOTHORAX DEPARTMENT OF SURGERY Presented by :- DEEPALI AGRAWAL Roll No.- 27 MBBS FINAL PART - II

2. CONTENTS •INTRODUCTION •INCIDENCE •CAUSES •PATHOPHYSIOLOGY •SIGNS AND SYMPTOMS •DIAGNOSIS •MANAGEMENT

3. Occurs due to a large open defect in the thorax (>3cm), leading to immediate equilibration between intrathoracic and atmospheric pressure. There is direct communication between the pleura and the atmosphere. Also known as sucking chest wound. INTRODUCTION

4. When wound is > ⅔ tracheal diameter: Inspiration pulls air through the wound into the pleural space. Air does not flow through the trachea into the lungs. •Air accumulated in hemithorax with each respiration, leading to profound hypoventilation on the affected side and hypoxia.

5. INCIDENCE It is estimated that open pneumothorax occurs in 80% of all penetrating chest wounds with stab wounds being more common than gunshot wounds.

6. Trauma -Blunt -Penetrating Iatrogenic -Transtracheal aspiration -Lung biopsy -Tube thoracostomy CAUSES

7. Air enters pleural cavity through open,sucking chest wound. Negative pleural pressure is lost permitting collapse of ipsilateral lung and reducing venous return to heart. Mediastenum shifts, compressing opposite lung. As chest wall contracts and diaphragm rises, air is expelled from pleural cavity via wound. Mediastinum shifts to affected side and mediastinal flutter further impairs venous return by distortion of venae cavae.

8. SIGNS & SYMPTOMS Sudden chest pain Shortness of breath Rapid and shallow breathing Tachycardia Hypoxia

9. •Clinical diagnosis should be made during primary survey. • INSPECTION - Wound seen that appears to be 'sucking' air (sometimes audible) into the chest cavity during inspiration and may produce bubbling blood during expiration. -Rapid shallow breathing which worsens as lung expansion decreases. •PALPATION - Trail Sign -mediastinum shifted to the opposite side. • PERCUSSION - Hyper resonance. • AUSCULTATION - Poor air entry detected in the affected hemithorax. DIAGNOSIS

10. RADIOLOGICAL DIAGNOSIS Computerized tomography (CT) Chest X-ray Ultrasound - more useful than a chest X-ray. If a patient is very unstable with a suspected open pneumothorax, treatment is typically initiated before imaging is used to confirm the diagnosis.

11. MANAGEMENT INITIAL MANAGEMENT •Provide the patient with high flow oxygen via a face mask. •Control any visible bleeding by direct pressure.

12. •Apply sterile non porous oclussive plastic dressing over the wound. - Prevents air from entering the wound during inhalation - Allows air to escape through wound during exhalation. Tapped on three sides to act as flutter type valve. - Prevents conversion to tension pneumothorax

13. DEFINITIVE MANAGEMENT Inserting a needle or chest tube between the ribs to remove excess air. High incidence of underlying injuries require surgery.

14. COMPLICATIONS Respiratory failure Cardiac arrest Pneumopericardium Pneumoperitoneum Hemothorax Bronchopulmonary fistula Damage to neurovascular bundle during tube thoracostomy Pain and skin infection at site of tube thoracotomy

15. THANK YOU