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OPEN PNEUMOTHORAX - CHEST SEALS

Updated: May 7, 2023

Your role as a Protector that has lifesaving skills is to treat the most common causes of death especially, which are massive hemorrhage and airway/ respiratory problems and to mantain the victim alive until the professional medical care arrives. I will talk today about OPEN PNEUMOTHORAX or more know as sucking chest wound. This can be produced by a gun shoot, stab or any mechanical exterior force that has the energy to penetrate the thoracic box and the pleura(the space between the thoracic box and the lungs).


Sucking chest wounds are dramatic, but rarely life threatening. The sound of sucking & blowing is the sound of not dying of tension pneumothorax. There is no good evidence an open pneumothorax needs to be sealed and you can cause tension. Your role as a Protector that has lifesaving skills is to treat the most common causes of death especially, which are massive hemorrhage and airway/ respiratory problems and to mantain the victim alive until the professional medical care arrives. I will talk today about OPEN PNEUMOTHORAX or more know as sucking chest wound. This can be produced by a gun shoot, stab or any mechanical exterior force that has the energy to penetrate the thoracic box and the pleura(the space between the thoracic box and the lungs). Although the open pneumothorax or “sucking chest wound” is dramatic in appearance, it is rarely fatal. The Open Pneumothorax can develop in a Tension Pneumothorax, that can be fatal.



When we talk about this injury made with a knife, we must understand that the probability of hitting this area is very high because the lungs are big targets placed in the upper body box. When we analize the statistics of real violent knife attacks we see a big percentage of victims suffering this type of injuries.

Following the TCCC MARCH algorithm the OPEN PNEUMOTHORAX comes at

R-Respiration.


M-MASSIVE HEMORRHAGE

A-AIRWAY

R-RESPIRATION

C-CIRCULATION

H-HEAD INJURY & HYPOTHERMIA

How we look for an Open Pneumothorax? All the time we look for holes in the body, wounds from the neck, to the abdomen. Especially in a shooting scenario, the bullet can enter at the level of the abdomen and change trajectory. The CHEST is examined using the acronym – FLAPS.

F – Feel

L – Look

A – Auscultate & Armpits

P – Percussion

S – Search the back

The NECK can be examined using the TWELVE acronym:

T – Trachea

W - Wounds

E – Emphysema

L – Laryngeal crepitus

V – Veins, distended or flat

E - Evaluate


LIFE-THREATENING CHEST INJURY

Respiratory distress means DIFFICULTY BREATHING ( rapid or abnormally slow breathing) , in other words, it is difficult for the casualty to get air in or out. The pleural space between the lungs and chest wall naturally has negative pressure which helps the lungs to collapse (exhale) and expand( inhale) . With either a BLUNT or PENETRATING INJURY to the chest wall or lungs, air may counteract the lung’s natural tendency to expand and collapse. This is due to positive pressure replacing negative pressure. Resulting in air being trapped in the pleural space putting pressure on the affected lung. This forces the lung to collapse and reduces the ability to get oxygen to the body. Identification Gunshot or shrapnel wound to the chest (penetrating trauma) Blunt force trauma ( force from an IED explosion, high-impact vehicle accident (chest hitting steering wheel ) , etc. ) Bruising, contusions (swelling around the chest, back or ribcage) , crepitus which is felt or heard (crackling, popping, grating)

ANY deformities of the chest

LIFE-THREATENING CHEST INJURY

•These injuries can lead to a tension pneumothorax

•This is the 2nd leading cause of preventable deaths.

Symptoms: Chest pain Tachypnea Dyspnea


CHEST SEALS

You can see in the image bellow 2 types of chest seal brands that I have in my medical trauma bag. There are Vented and Nonvented Chest seals. Vented chest seals are for treating penetrating wounds to the chest. Vented chest seals allow air to escape out of the chest while nonvented chest seals do not. The injured lung will remain partially collapsed, but the mechanics of respiration will be better. If vented chest seal is not available, a nonvented chest seal should be used. When the casualty inhales, the plastic should be sucked against the wound, preventing the entry of air. When the casualty exhales, trapped air should be able to escape from the wound and out the valve. Check the back or the front of the victim, and look for an exit hole, as well. If there is one, apply a chest seal to that area, as well.




Once the seals have been applied, you will have to monitor the person and possibly burp or release pressure by lifting up one side of the dressing.

− If the casualty has a chest seal in place, burp or remove the chest seal.

− Place the casualty in the supine or recovery position unless he or she is conscious and needs to sit up to help keep the airway clear as a result of maxillofacial trauma.



In this video you can see an open pneumothorax and an improvised chest seal, created from petroleum gauze and duct tape, closing it on 3 sides and one remains free. Very important to understand that improvised equipment must be your last resort when you don't have other options(commercial professional medical equipment).



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