Trauma from a gunshot, knife wound or high force blunt trauma, like a car accident, can all lead to a punctured lung. Typically when the lung is punctured, it leads to a traumatic pneumothorax, or a collection of air between the lung tissue and the chest cavity, or pleural space. It is not a common condition but can be life threatening and needs rapid assessment and treatment. The treatment will depend upon the size of the injury and the response of the lungs and surrounding tissue.
Typically people with this type of injury will either report directly to the emergency room or have an emergency medical service respond to the scene. As this injury is accompanied by shortness of breath, the first thing an emergency medical responder will do is provide supplemental oxygen. This oxygen will help accelerate pleural resorption of air, a faster decrease in air between the lung and the chest cavity.
A large chest wound that penetrates to the lungs may cause a sucking chest wound, in which air is pulled in through the wound every time the person attempts to breath. Medical professionals place a special bandage that contains petroleum jelly on the wound to create a seal. The bandage will only be taped on three sides so air can escape the wound but not return.
Wait and See
After seeing a doctor, if the wound is small, the doctor may choose a "wait and see" approach. Small areas of punctured lung may not collapse and can heal on their own. It is important to let the doctors make this decision verses waiting as a delay in treating a lung puncture can lead to complications like the lung not reinflating properly or severe infection.
Catheter Aspiration and Tube Insertion
A small bore needle may be inserted between the second and third ribs into the air that has filled in between the lung and chest cavity. One side of the needle is attached to a syringe and the syringe is used to remove air from the chest space and release the air into the room. This is done until the lung is reinflated or until 4 liters of air has been removed. If this is unsuccessful, a tube will be placed in the lungs.
A tube may be inserted in a similar fashion to the needles, but the tube is attached to a suction device that slowly removes the air over the course of several hours or days. Tube treatment may also include a round of antibiotic therapy to prevent infection.
A large puncture wound will be a surgical case as the lung tissue will not be able to immediately close and repair itself. The surgeons will likely work to repair the lung tissue by going through tubes placed down the throat into the bronchial airways. If this method does not work, surgeons will have to make a skin incision. Additionally the surgeons may place in a tube to remove access air and may have to suction out any blood cells or other fluids in the pleural space.