How to manage open pneumothorax?
When trauma causes chest injury, the pleural cavity connects to the outside, forming an open pneumothorax. Patients will experience severe respiratory distress, cyanosis of the lips, weak pulse, and severe shock, which can lead to electrolyte imbalance or organ failure, seriously endangering their lives. They must receive treatment as soon as possible.
So how do we treat open pneumothorax?
1. Seal the chest wall wound. In the event of an open pneumothorax, immediate first aid should be administered to seal the chest wall wound as quickly as possible, turning it into a closed pneumothorax. Use thick gauze pads and a sufficiently thick dressing to secure the wound, then immediately transport the patient to the hospital.
2. Blood transfusion, fluid replacement, and oxygen therapy. Upon arrival at the hospital, immediate blood transfusion, fluid replacement, or oxygen therapy should be administered to correct respiratory obstruction, maintain airway patency, and further examination of the injury should be conducted.
3. Debridement. After the patient's overall condition improves, debridement will be performed under endotracheal intubation. If there is no organ damage or severe infection, the wound can be sutured after debridement. If the wound is heavily contaminated, debridement should be performed first, followed by suturing at an appropriate time. If there is organ damage but the wound is not severely contaminated, the wound can be enlarged for thoracic surgery. If the defect is large, periosteal coverage or pedicled myocutaneous flap filling may be performed. Postoperatively, a drainage tube should be left in place for continuous drainage.
4. Medication. Antibiotics are needed after surgery to prevent infection; cephalosporins are usually chosen. If the pain is severe, analgesics can be used.
The above describes the treatment methods for open pneumothorax, including closing the chest wall wound, blood transfusion, fluid resuscitation, oxygen therapy, surgical debridement, and medication. Open pneumothorax is very serious and often life-threatening. Some patients develop complications such as pleural effusion, hemopneumothorax, or septic shock, making their condition even more critical and requiring a race against time for resuscitation. During treatment, close monitoring of vital signs is essential, and the amount and nature of drainage fluid must be recorded daily. Patients also need regular chest X-rays to determine if there is pleural effusion, lung expansion, or other abnormalities.