Management of Emergency Open Thoracostomy in Trauma

Initial Assessment and Management

The American College of Surgeons recommends immediate debridement and suturing of the open pneumothorax wound, followed by closed thoracic drainage to prevent tension pneumothorax development, in patients with emergency open thoracostomy in trauma 1, 2
Open pneumothorax presents with progressive dyspnea, sucking or hissing sounds through the chest wall wound, and foamed blood at the injury site, requiring immediate priority to prevent air entry through the chest wall defect while maintaining adequate ventilation 3

Patients with emergency open thoracostomy in trauma remain at significant risk for developing tension pneumothorax, especially under positive pressure ventilation, and require continuous monitoring, as tension pneumothorax can cause death within minutes if unrecognized 1, 3

The Eastern Association for the Surgery of Trauma recommends damage control thoracotomy for patients with initial drainage volume after closed thoracic drainage exceeding 1000 ml or drainage continuing at more than 200 ml per hour for over 3 hours despite anti-shock treatment 6, 2, 5
The Western Trauma Association recommends damage control thoracotomy for patients with closed thoracic drainage that cannot relieve dyspnea or leads to continuous hemorrhage in severe pulmonary lacerations 7, 8

The American Heart Association recommends resuscitative emergency thoracotomy for patients with cardiac arrest or impending cardiac arrest, usually within 15 minutes, with effective blood transfusions, fluid infusions, and anti-shock treatments 1, 2, 5, 4, 7

The Society of Critical Care Medicine recommends inserting a drainage tube in the fourth/fifth intercostal space for closed thoracic drainage in patients with massive hemothorax, presenting with chest pain, shortness of breath, attenuated breath sounds on the injured side, and signs of shock 1, 5, 3
The American College of Cardiology recommends pericardiocentesis at the subxiphoid site or cardiac apex, preferably with ultrasound guidance, for patients with pericardial tamponade, which may develop from penetrating or blunt injury 6, 1, 2