Open pneumothorax (sucking chest wound)
An open pneumothorax occurs when a full‑thickness chest‑wall defect allows atmospheric air to communicate with the pleural space. Air passing through the wound abolishes the normal negative intrapleural pressure, commonly causing collapse of the ipsilateral lung, impaired ventilation and hypoxia.
If the defect or subsequent management creates a one‑way valve, tension physiology can rapidly develop. Open pneumothorax is potentially life‑threatening and requires prompt recognition and the correct initial and definitive interventions.
Pathophysiology
Normal ventilation requires a sealed pleural space with negative intrapleural pressure.
A chest‑wall defect permits passive inflow of air during inspiration; when the wound aperture offers less resistance to airflow than the trachea (classically when large relative to tracheal diameter), ventilation may occur preferentially through the wound, producing ineffective tidal ventilation and ipsilateral lung collapse.
Occluding the wound without providing a route for egress, or delivering positive‑pressure ventilation, can convert a simple open pneumothorax into a tension pneumothorax.
Clinical features
Typical findings include an obvious penetrating chest wound, audible sucking or bubbling with respiration, dyspnoea and hypoxia. Examination may show reduced ipsilateral chest expansion, diminished breath sounds and hyperresonance when a pneumothorax is present. Associated injuries (cardiac, major vessel, pulmonary contusion) are common - maintain a full trauma assessment.
Immediate priorities (ABCDE)
Start with scene and rescuer safety and control of external haemorrhage....