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Chest wounds and needle decompression.

Warning: Do not try these procedures unless you have been trained. This is for information purposes only.

Your body has two lungs approximately the size of your hand. Each is enclosed in a separate airtight area in the chest. If an object pierces the chest wall and allows air to enter one of these areas, the lung inside that area will begin to collapse.

Any degree of collapse in either of the lungs will interfere with the patient’s breathing and reduces the oxygen available for the body to use.

When an object penetrates the chest wall it is an open chest wound. Combat causes of this could be.

  • Bullet
  • Knife
  • Shrapnel
  • Stick
  • Blast debris

    Signs and symptoms of an open chest wound are

  • Sucking or hissing sounds from wound “sucking chest wound”
  • Casualty coughing up blood
  • Frothy blood coming from wound
  • Shortness of breath / Difficulty breathing
  • Chest not rising normally during inhalation (fractured ribs, resulting in a flail chest)
  • Pain in shoulder or chest that increases with breathing
  • Bluish tint of lips, inside of mouth, fingertips, or nail beds caused by a decrease of oxygen in the blood (cyanosis)
  • Rapid and weak heartbeat (shock)

    If you have a possible chest injury you will need to expose the wound. The easiest way to do this is with medic shears. I carry these on my 2nd line gear. They work much better and faster then trying to cut off the clothes with a Rambo knife. Do not clean or remove impaled objects and clothing stuck in the wound. Look and feel for the wound.

    Since air can pass through dressings and bandages you will need to use an occlusive dressing which is an airtight dressing. Any wound between the abdomen and neck can possibly let air into the chest so it must be sealed correctly.

    Directly cover the entrance hole if it is on the patient’s front with a 3 sided dressing. This will allow air to escape (flutter) but keep air from entering the wound. Here an MRE wrapper is being used with heavy medical tape. You could also use the pouch your field dressing comes in, Vaseline dressing, gum wrapper, ziplock etc. Make sure the wound is covered by at least 2 inches of the material. If there is an impaled object you must leave it in, secure it in place and seal the wound around it. Have the patient hold their breath when you apply the dressing. If the patient is unable to hold their breath, apply the dressing when the chest falls and before it rises again. Once in place the patient may resume normal breathing.

    Find the exit hole and cover it with an occlusive dressing sealed on all 4 sides so no air can enter or leave. It may be next to the entrance, on the opposite side, above, below or to the side of the entrance wound.

    After you have the occlusive dressing on you can apply your 4x4, battle dressing or larger trauma dressing depending on how large the wound is to cover to protect the wound and the dressing.

    If 2 or more ribs are broken you may have a case of flail chest. When you see the broken ribs move opposite of the chest wall you will need to apply a heavily padded dressing to the wound to secure the flail chest section.

    After you have applied the sealed dressings and bandages move the victim to the recovery position with the injured side to the ground.

    If you have access to one you can use an Ashermen chest seal for the wounds. They are large sterile valves which will let you stick it directly to the wound and allow air to escape but not enter it. The seal comes with gauze to clean the site to apply it first. This is a very fast way to seal a possible sucking chest wound.

    If the wound is over the abdomen and intestine are exposed do not push them back into the body but cover the intestine with a wet dressing. If you don’t the intestine will dry out and will have to be cut out. If you have an abdominal wound, check the patient’s underware for feces. If there is none, smell the abdomen for the smell of feces. If there is an oder he may have fecal matter loose inside him which will cause complications and possible septic shock later.


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