Micro-lectures

Paramedics Course – Open Pneumothorax

Open Pneumothorax

Micro-lecture by the Australian Paramedical College

 

In today’s micro-lecture, Australian Paramedical College Hon. Snr. Lecturer Sam Willis talks about pneumothoraces, which is the tension pneumothorax that usually gets quite a bit of attention but is often under discussed.

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Open Pneumothorax


In today’s micro lecture, we’re going to talk about an open pneumothorax. Now when we talk about pneumothoraces, it’s the tension pneumothorax that usually gets quite a bit of attention, but there is also this thing called an open pneumothorax that I think is personally under discussed. So let’s just recap them. In the tension pneumothorax, you have a situation whereby there’s a buildup of air in the pleural space, and every time the patient takes a breath in, air sucks into that space and compresses the lung, and that’s called a tension pneumothorax.

Now, on most occasions, a tension pneumothorax occurs in this mechanism whereby there’s something stopping the air leaving the injured area. So for example, if somebody is shot in the chest or stabbed, then there’s a flap of skin that seals itself up, which usually allows air in but not out.

Now, the open pneumothorax has very similar principles except on many occasions the open area is actually still open again, allowing air to suck into the chest and the buildup and compress the actual lung itself, which in many occasions then leads to the tension pneumothorax.

Now the word tension remember occurs once the lung has been compressed so badly that it pushes the other organs, the heart and the trachea, the lungs away from the site of the injury. So I can actually show you what this looks like here. So here’s an actual photo of an open pneumothorax. So here the chest wall is still open and as you can see, the air will just naturally go into this space rather than going into the normal mechanisms, so for example, through the nose and the mouth. But that hole has to be more than one third the size of the diameter of the trachea for that to happen. Now as the paramedic, it’s your role to apply what’s called an Asherman seal, or at least some kind of seal to prevent the air from going into this injury, and therefore minimising the potential for a tension pneumothorax.

Now on this image here, you can see just a normal three way occlusive dressing. So you’ve got a dressing, you’ve sealed the one side here, one side here, one side here, and you’ve allowed this side here to let the air out. So it says, take down three sides and allow the air to drain out. Now there are different seals, for example, an Asherman seal, which you guys can probably look at in your, there you go, there’s one there, the Asherman chest seal. And these are designed to do a better job of this makeshift seal that we can do here. But in principle it all has the same effect. As you can see, the idea is that the air comes down and instead of hitting, going in through that hole, it actually is deterred by the actual dressing itself. So that’s a micro lecture on the open pneumothorax.

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