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Traumatic Pneumothorax

AMA Arch Surg. 1957;75(5):727. doi:10.1001/archsurg.1957.01280170037020.
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The important pathophysiologic aspects of the various types of pneumothorax have been emphasized. Two observations on the emergency treatment of the chest casualty deserve reiteration: (1) Open or "sucking" wounds of the chest should be occluded as soon as possible, and (2) tension pneumothorax should be recognized and treated immediately to relieve the increasing intrapleural pressure. The ideal therapy for pneumothorax of significant extent is intercostal catheter, water-seal drainage of the pleural space. A plastic-encased, one-way flutter valve has been developed and proved satisfactory as a substitute for the water-seal trap when evacuation of the patient is anticipated. Hemothorax is commonly associated with traumatic pneumothorax; if bleeding continues, a thoracotomy may be necessary to prevent exsanguination of the patient. The restoration of cardiopulmonary physiology takes precedence over all other aspects of trauma. If this is not appreciated, the patient may not survive the operation, no matter how magnificently it is


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