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Hissing and frothing of blood from chest holes due to gun shots

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I have 2 holes in the left side of my chest due to gunshot and 4 gashes on my upper left torso from a knife, also have a few gashes on my left shoulder, and my ribs are broken on the left side as well. Every time I take a breath, a weird hissing sound, along with frothy blood comes out of the holes in my chest, making it hard for me to breathe. What will the EMTs and doctors do to treat my condition, and after I leave the hospital, what can I do for self care at home? Do you know why the holes make a hissing sound? Also, are the holes in my chest serious? Why can't I breathe deep?


Category: Family Physician-GP

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Category: Allergy and Immunologist
Dr. Jacob George Pulinilkunnathil is online now

Expert:  Dr. Jacob George Pulinilkunnathil replied 4 Days.

Consult reply by Dr.Jacob George (Pulmonologist).

Thank you for using DoctorSpring services. I would like to know some additional information from you. What kind of treatment are you getting ? Is there a Chest tube connected to your chest ? Was a CT scan done, if so what does it show ?

A brief outline on your treatment will give me more clarity so that I can form a better and learned opinion.

Thank you


Patient replied :

The EMTs used a Bolin chest seal on both holes, and bandaged the gashes on my left side. I'm still on oxygen, and I'm awaiting surgery because I have 3 holes in my left lung.


Expert:  Dr. Jacob George Pulinilkunnathil replied 3 Days.

Hello,

The gushing sound is due to air communication to outside.(due to negative pressure during breathing air will go in, goes out while expiration) This will be treated by closing the wounds. This will help in maintaining a good respiratory volume. There might be chest tube to move the air trapped inside your pleura. Pain management will be important as it will help in breathing. I will give some general guidelines here. BUT it will be better if you contact me at the time of discharge for guidelines regrading home care. I will keep this consult open. (I will need your physical status during discharge.

. Your focus now should be wound care until your wounds have properly healed. Yes there is still hissing and difficulty when you breath due to your injuries and inflammation in your chest. Here are some suggestions of what you can do now at home:
1. Keep your wounds clean and change your dressings often if they are getting soiled.
2. Avoid excess strain or strenuous activity during your recovery period. Allow your body time to heal as it you have suffered injuries to your bones and soft tissues and it will take time.
3. Practice breathing exercises often to promote good respiration. Breath in deeply and hold for a few seconds, 10 breaths at a time, or start wherever you feel comfortable. Work closely with a physical therapist who can guide you through more breathing exercises, physical exercises, and also keep you motivated. You will need to start slow as your body will allow, and slowly progress to longer breaths.
4. If you do have a chest tube, make sure to protect it during coughing and straining. Try to avoid coughing, and if you must hold towel over your chest tube opening to prevent dislocation
5. Take the painkillers as prescribed by your local physician as needed. Avoid constipation and any other stress than can cause pressure and interrupt your wounds.

If you start to experience confusion, dizziness, fever or severe bleeding then you will need to seek immediate medical attention as this could be a sign of hemorrhage or sepsis (infection). Furthermore, for complications of the chest, breathing, and chest tubes (if present) make a visit to your local respiratory physician or pulmonologist. For assistance in breathing exercises, make regular visits to a physical therapist. Hope this helps. Take care.


Patient replied :

There was another hole in my chest that they missed during the surgery, so they used another Bolin Chest Seal and I'm still on oxygen via mask. The nurse keeps using a stethoscope on the left side, and asked me to breathe every time they move the stethoscope to another place on my chest. I don't have a chest tube. They are considering a second surgery. I'm bleeding severely from the gashes and the 3 holes. The blood is seeping through the bandages, and they took x-rays of my ribs. Also, my left forearm is broken so it's in a sling. My arm feels heavy and it's making it harder for me to breathe deep.


Expert:  Dr. Jacob George Pulinilkunnathil replied 2 Days.

Hello,

I am sorry to hear about your trouble. The nurse is checking for air entry. (The air entry could be decreased due to presence of air or water in the pleura). The second surgery is essential. Do not worry about the blood loss. It might seem too much but essentially it will be mix of air froth and other secretions. I am sure your Doctors will be checking your blood Hb levels. So any drop will be easily identified.

Hope this helps
Please do feel free to ask followup questions.
Thank you


Patient replied :

The doctor attached a chest tube in my chest, and the nurse is still checking with the stethoscope. The holes are still covered with bolin chest seals, gauze and ace bandages are wrapped around my chest and shoulder. My left arm is also in a sling but they couldn't cast my arm, so it's in a splint. They are checking for more holes in my lungs and chest that they may have missed. I'm still on oxygen via mask. My ribs are still broken, and they want to check if they punctured my lung or not. I am dizzy, and I'm cold. The nurse is asking me to breathe deep each time she moves the stethoscope to a different place on my chest. And another nurse is trying to control the bleeding from seeping out of the bandages. I feel like I'm suffocating, and I'm still struggling to breathe.


Expert:  Dr. Jacob George Pulinilkunnathil replied 1 Day.

I understand the recovery process is painful . But lungs have a good recovery capacity. So I recommend you to stay positive and not to mind the pain ! Pain will be your biggest enemy to recovery. Do no restrict lung movements because of pain (unless very severe). I am sure your Doctors are treating you will. Chest tube will drain the fluid and air from the lungs and will help in your recovery.

Thank you


Dr. Jacob George Pulinilkunnathil
Category: Allergy and Immunologist
Experience: 
Residency, Post Graduation: MD, Respiratory Medicine, J L N Medical College, Ajmer, Rajasthan (2012).
Medical School, Internship: MBBS, Government Medical College, Kottayam, 2001-07 
Indian Diploma in Critical Care Medicine (IDCCM) - Medical Trust Hospital, 2013-2014.
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