Somehow, I Don’t Think “Oops” Quite Covers It

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.