Sent to me by a friend, an ER nurse in a major trauma center, in an e-mail the other day:
Guy comes in last evening with an abscess on the left lower chest wall, been there for about a week. It was I&D’d (incision and drainage procedure) here a few days ago, and he was kept as an inpatient for a day or two.He said “They were giving me antibiotics, and when they cut it they kept sticking their fingers in it.”
He presented to me at triage last evening with a chief complaint of continued chest wall pain at the site, shortness of breath, and “it feels hard around it (the incision),” and…get this…”when I breathe, I also feel air coming in and out through the hole they cut.”
Yup. Guy had an open sucking chest wound, and the hardness was subcutaneous crepitus. I wonder how long it has been like that, as he looked surprisingly good, considering. I threw a quick Tegaderm over it and hustled him to the trauma room.
Someone is gonna dread Morbidity and Mortality Review this month.
Heh, I’ll bet.
I’ve actually seen relatively few sucking chest wounds in my career. The sheer physics of it make it fairly unlikely; in order to have a sucking chest wound, air has to pass through the wound more readily than it would through the patient’s trachea. That requires a pretty big permanent wound channel, and even the larger caliber handguns don’t typically leave such a large hole.
I’ve seen a couple of sucking chest wounds left by big knives, and in one memorable instance, a length of galvanized electrical conduit, but the only sucking chest wounds I’ve seen left by firearms were in deer I’ve shot.
Pistols and pocket knives rarely leave a hole large enough to allow easy entrainment of air. Nor do scalpels.
Well, unless the doctor wallows out the hole with his finger, that is.
Sounds like the crew at "Cycles & More" worked on this guy.
word verification: cophike – that lengthy trip from the squad car to the donut shop?
I saw two during my VFD days… One caused by a length of guard rail (along with 9 broken ribs), one by a slat on a stake bed truck that was rear ended (definitely NOT equal and bilateral…). Neither was pretty, but Saran Wrap and tape allowed us to get them to the hospital alive.
Sounds like the hospital @#&* this one up…
When you're crazy enough to run a 5/8" drill through your chest so the gnomes can escape, a sucking chest wound can happen too….ask me how I know.
Word Verification: Dripe – The causative symptom that takes you to the clinic for a PCN shot after spending the night with a skanke.
But tell me this.. did they at least get the abscess drained?
Did anyone bother to listen to his lungs BEFORE he left he hospital the first time?!
We were taught never to say "oops". We were trained to say "hmm, that's interesting" instead.
Wow…. nuts.
That'll buff right out!
(Someone had to say it!)
Bravo Zulu, docs. Very BZ.
/sarcasm
At least he used his finger and not say a… broom handle.
Anonymous,
Good call on the Cycles & More sign. The patient is worse after the intervention, than they were before.
One way to do this with a small opening is to have a patient with some kind of airway obstruction at the same time as the iatrogenic aperture. Not that this is a recommended way of treating patients.
We once had a prisoner that had to get a tube inserted into his lung – it partially collapsed. I'll never forget the screaming.
I've seen a few sucking chest wounds over the years. Well, figuratively ALL chest wounds suck, but that's not what I mean.
All of them have been from knife or other edged implement wounds, none from gun shots.
Most of what we are taught about GSWs and sucking chest wounds comes from military medicine where rifle caliber wounds are the norm. In the civilian setting, smaller and usually slower bullets cause smaller wounds which are less likely to meet the requirements imposed by the laws of physics in order to create sucking chest wounds.
Why we persist in teaching the wrong lessons in wound care never ceases to amaze me.