A fish induced pneumothorax: dilemmas in the remote management of a sucking chest wound

BMJ 1996; 313 doi: (Published 21 December 1996) Cite this as: BMJ 1996;313:1617
  1. David Berger, ex-senior medical officera
  1. a Gizo Hospital, Solomon Islands
  1. Correspondence to: Dr D Berger, 1 Yelland Cottages, High Bickington, Umberleigh, Devon EX37 9BX.

    The call came, as such calls always do, at dinner time. It was Jenasi, the very capable nurse from Seghe clinic in Marovo Lagoon, on the radio. A man had just been brought in, having been attacked by a barracuda earlier in the day. He had a large gash in his chest, through which air was passing in and out as he breathed, but his observations were stable and he was not cyanosed. Hmmm.

    The sun had just set, which in the Solomon Islands means no evacuation, by air or otherwise, until first light. Should the wound be packed to stop the movement of air or not? We conducted a straw poll among the doctors: our ex-army officer said it definitely should be, as otherwise he was in danger of developing paradoxical breathing; our general practitioner surgeon said probably not; and the Swiss orthopaedic surgeon in the capital, who we contacted by phone, said definitely not as there was no possibility of putting a drain in should he develop a tension pneumothorax and he was currently well. (My own contribution was only to …

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