Question

If a person suffers a gunshot or knife wound to the chest, a pneumothorax can result. Essentially a hole in the chest cavity, air from the outside can pass directly into the pleural cavity. What effect would this have on lung function? Could a person still breathe? What is the fix for this problem?

Grading Rubric:

Described what effect pneumothorax has on lung function

Described how well a person could breathe

Described the procedure for repairing and restoring normal lung function

Answer 1

The condition in this is tension pneumothorax occurs due to knife stabbed on chest

Traumatic pneumothorax occurs after some type of trauma or injury has happened to the chest or lung wall. It can be a minor or significant injury. The trauma can damage chest structures and cause air to leak into the pleural space.

tension pneumothorax occurs when the patient cannot compensate, and several events begin to occur that can lead to death. As air fills the pleural space on inspiration through the opening with an open pneumothorax, the wound can act as a one-way valve and not allow the air to exit. This leads to a cascading effect on the patient.

As more air enters the pleural space, the pressure in the space increases and begins to collapse the lung on the injured side. As the injured lung collapses, there is less air that can be exchanged for perfusion in the lung. Once the lung has collapsed, pressure begins to compress the heart, shifting the mediastinum toward the uninjured lung. This triad of a collapsing lung, shift in the mediastinum, and rebreathing is the beginning of a rapid deterioration of a patient's ability to maintain oxygenation.

As this continues, the compression of the vena cava reduces cardiac blood flow to the heart and decreasing cardiac output. This leads to difficulty breathing, and tachycardia. A noticeable shift in the trachea will be evident. This entire process leads to a life-threatening condition known as a "tension pneumothorax." The patient in this condition will die if treatment is not provided.

To restore all the lung function back  

A needle decompression involves inserting a large bore needle in the second intercostal space, at the midclavicular line. Once this is done, there should be an audible release as the trapped air, and as the tension is released the patient should begin to improve.

A needle decompression should only be performed if the patient has a tension pneumothorax. When inserting the needle, it should be inserted at a 90 degree angle to the chest wall. This is a critical point as this will position the needle straight into the pleural space. If any other angle is used, there may be a chance of hitting other structures in the area such as major blood vessels or even the heart.

The following are steps to perform a chest decompression. However, you should follow your own protocols.

Ensure patient is oxygenated if possible
Select proper site
a. Affected side at the second intercostal space and along the mid-clavicular line
b. Note: Draw an imaginary line from the nipple up to the clavicle. The needle should not be closer to the middle of the chest than this line
Clean site with alcohol or povidine solution
Prepare needle; if it has a leur-lock or flash chamber, it will need to be removed
Insert the needle into the second intercostal space at a 90 degree angle to the chest, just over the third rib.
Note: There are blood vessels running along the bottom of the ribs. Ensure the needle is closer to the top margin of the lower rib in the intercostal space. This will prevent these vessels from being damaged.
Listen for a rush of exiting air from the needle
Remove the needle and leave the catheter in place, properly disposing of the needle
Secure the catheter in place with tape. Some suggest covering the end of the catheter, but this will depend on the situation
Ensure the tension has been relieved and the patient's condition improves. If there is no improvement, the procedure will need to be repeated with another needle placed adjacent to the first needle
Monitor, then reassess the patient