Problems of peculiar importance to thoracic injuries are open-chest wounds and tension pneumothorax. Open wounds of the chest must be converted to closed wounds in order to keep a functioning respiratory system. In the earliest phase of care, this may be accomplished by an adequate bandage. The picture of a patient with steadily increasing dyspnea, gasping respirations, and increasing cyanosis, in shock, with distended neck veins, flushed face, and a deviation of the trachea, with or without visible chest wound, may be diagnosed as indicating tension pneumothorax. The immediate requirement in such a situation is decompression, and this may be accomplished with any available needle. For transportation purposes, a needle may be left in place with a finger cot over the hub and a hole in one side to act as a flap valve. Injury to the lung parenchyma and bronchi poses two main problems, in addition to pneumothorax. These
BRUNE WH. Management of Trauma to the Lungs and Bronchi. AMA Arch Surg. 1957;75(5):724–725. doi:https://doi.org/10.1001/archsurg.1957.01280170034018
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