all I’ve done this week is work on personal statements and worry about recommendation letters (I emailed the doctor I used to work with, but he hasn’t responded)
AND I forgot to register as a pharmtech for the state board of pharmacy, which means I can’t work until 3-4 weeks from now.
"We can’t save everyone…though we try."
My resident says this with a sigh to our six man team: him, two interns, my fellow 4th year, the third year, and I, slouched, curled, and slumped in various positions on plastic rolling chairs in the unusually quiet 7th floor workroom at 6PM. No one wants to go home. Everyone feels a responsibility that tethers them to the hospital, that does not disappear, even when your heavy white coat is hung in a closet or thrown on the floor.
Oh, this will be a fun question to answer.
(Also someone please correct me if I’m wrong)
To understand what a sucking chest wound is, we first sort of need to understand the concept of a pneumothorax, a “collapsed lung”. Basically, under normal circumstances, your lungs operate under what’s called a negative pressure system. This negative pressure system means that the pressure in the “lungs” is more negative than the outside environment, which allows the air we breathe to flow into our lungs as we inhale. As we inhale, our chest wall expands, allowing the lungs to expand and decrease the air pressure, allowing air to flow from high to low pressure. Our lungs also have what’s called pleura, a membrane around each lung with two layers called the parietal pleura and visceral pleura. The parietal pleura is attached to the chest wall while the visceral pleura is attached to the lung itself. This membrane is very important in helping to establish the negative pressure system mentioned earlier. Importantly, the pleura have what’s called the pleural cavity, which is a potential space. What this means is that under normal physiological conditions, there is no actual space between the pleura other than the small amount of pleural fluid between them. But there is the potential for their to be space under abnormal conditions.
So, because the lungs operate under negative pressure, this means that air will flow from high pressure to low pressure under almost all circumstances. This is how pneumothoraces are created. A pneumothorax is caused when air enters the pleural cavity, turning the potential space between the pleura into an actual space. This is usually due to trauma (gun shot wounds, stabbings, rib fractures) but can sometimes be due to things like COPD, cancer, and interstitial lung disease. The creation of the actual pleural space is bad because air will travel from the path of lease resistance, and oftentimes create a large pleural space when one shouldn’t exist. This now existing pleural space separates the lung from the chest wall, preventing it from being able to expand and placing pressure on the lung. This is why we use chest tubes to correct a pneumothorax. The tube is inserted into the pleural cavity, and connected to a vacuum pump to remove the air/fluid in the pleural cavity and restore the negative pressure environment and making a potential space rather than an actual space.
So, to answer your original question, a sucking chest wound is a very very serious type of traumatic pneumothorax. A sucking chest wound occurs when there is an open wound through the chest wall and into the pleural space, creating a one way route for air to enter the space. Air, like many other things, follows the path of least resistance. With every breath someone with an open pneumothorax takes, more air will enter the pleural space, making the situation worse. These sucking chest wounds get their name because you can sometimes literally hear a sucking sound coming from the wound as air enters into the chest wound during inspiration, and you will also see blood bubbling during inspiration and expiration.
I hope this answers your question and wasn’t too long of an answer!