Complications and management of traumatic pneumothorax?
Traumatic pneumothorax is often accompanied by hemothorax; therefore, it is necessary to treat not only the pneumothorax and hemothorax simultaneously, but also to promptly address any accompanying complications.
① Treatment of heart and major blood vessel injuries
The key to successful resuscitation is rapid diagnosis and early surgery. Patients with open cardiac injuries accompanied by massive bleeding, shock, or suspected cardiac tamponade should be immediately transported to the operating room for open-chest surgery to avoid any delays in treatment.
② When there is a chest injury, do not miss an abdominal injury.
Combined chest and abdominal injuries are common, but abdominal injuries are often more hidden and easily overlooked because the sudden increase in abdominal pressure at the time of injury can damage the diaphragm and abdominal viscera. Lower chest injuries should raise suspicion of diaphragmatic and visceral damage. If diaphragmatic injury is found, the abdomen must be examined, and damaged organs should be repaired as much as possible. If hemopneumothorax and peritoneal irritation are present, abdominal paracentesis and X-ray examination should be performed as soon as possible to establish an early diagnosis. Once diagnosed or highly suspected, an effective intravenous access should be established first to identify the main cause of life-threatening complications and provide targeted resuscitation. Chest injuries, especially abdominal injuries, often lead to shock and respiratory failure, resulting in a high mortality rate. Based on the history of trauma, thoracotomy and abdominal paracentesis are simple and reliable diagnostic methods, followed by X-ray and CT scans to establish a definitive diagnosis.
③Major bleeding
Treatment should prioritize addressing massive bleeding. For injuries to the heart, major blood vessels, trachea, or bronchi, thoracotomy should be the first-line procedure. If thoracotomy is not indicated, laparotomy should be performed. Preoperative closed-chest drainage should be placed to prevent intraoperative respiratory distress and allow for chest assessment. Traumatic hemopneumothorax is often accompanied by rib fractures and prolonged pulmonary contusion. Excessive administration of large amounts of crystalloid fluids for shock can easily induce ARDS. In cases of traumatic hemopneumothorax, especially bilateral pulmonary contusion complicated by shock and multiple organ injuries, ARDS should be considered. After shock correction, fluid resuscitation should be strictly controlled, and plasma and albumin should be replenished as quickly as possible. Liver and kidney function and blood biochemistry should be monitored regularly, and blood gas analysis should be performed periodically to detect ARDS tendencies and facilitate early intervention and treatment.