Paul April O, Kirchhoff Chlodwig, Kay Michael V, Hiebl Albert, Koerner Markus, Braunstein Volker A, Mutschler Wolf, Kanz Karl-Georg
Munich University Hospital LMU, Department of Trauma Surgery - Campus Innenstadt, Nussbaumstrasse 20, D-80336 Munich, Germany.
Patient Saf Surg. 2010 Jun 17;4(1):8. doi: 10.1186/1754-9493-4-8.
Thoracic injuries play an important role in major trauma patients due to their high incidence and critical relevance. A serious consequence of thoracic trauma is pneumothorax, a condition that quickly can become life-threatening and requires immediate treatment.Decompression is the state of the art for treating tension pneumothorax. There are many different methods of decompression using different techniques, devices, valves and drainage systems. Referring to our case report we would like to discuss the utilization of these devices.
We report of a patient suffering from tension pneumothorax despite insertion of a chest drain at the accident scene. The decompression was by tube thoracostomy which was connected to a Heimlich flutter valve. During air transportation the patient suffered from cardiorespiratory arrest with asystole and was admitted to the trauma room undergoing manual chest compressions. The initial chest film showed a persisting tension pneumothorax, despite the chest tube that had been correctly placed and connected properly to the Heimlich valve. We assume that the Heimlich valve leaves did not open up and thus tension pneumothorax was not released.
We would like to raise awareness to the fact that if a Heimlich flutter valve is applied in the pre-hospital setting it should be used with caution. Failure in this type of valve may lead to recurrent tension pneumothorax.
胸部损伤在重大创伤患者中具有重要影响，因其发病率高且关联性关键。胸部创伤的一个严重后果是气胸，这种情况会迅速危及生命，需要立即治疗。减压是治疗张力性气胸的常用方法。有许多不同的减压方法，使用不同的技术、设备、阀门和引流系统。参照我们的病例报告，我们想讨论这些设备的使用情况。
我们报告一例患者，尽管在事故现场已插入胸腔引流管，但仍发生了张力性气胸。减压通过胸腔闭式引流术进行，该引流管连接了一个海姆利希单向活瓣。在空运过程中，患者出现心脏呼吸骤停伴心搏停止，被送入创伤室并接受胸外按压。最初的胸部X光片显示尽管胸腔引流管放置正确且与海姆利希瓣膜连接恰当，但张力性气胸仍然存在。我们推测海姆利希瓣膜的叶片未打开，因此张力性气胸未得到缓解。
我们想提醒注意，如果在院前环境中使用海姆利希单向活瓣，应谨慎使用。这种瓣膜出现故障可能导致复发性张力性气胸。
