PERFORM FIRST AID FOR AN OPEN CHEST WOUND
Apply a dressing to a casualty with an open chest wound.
Given a simulated casualty with an open chest wound and needed supplies.
Score a GO on the performance checklist.
STP 21-1-SMCT, Soldier's Manual of Common Tasks: Skill Level 1.
FM 21-11, First Aid for Soldiers.
The body has two lungs. Each lung is enclosed in a separate airtight area within the chest. If an object punctures the chest wall and allows air to get into one of these area, the lung within that area can not fully expand (collapses). In order for both lungs to collapse, both sides of the chest would have to be punctured. Any degree of collapse, however, interferes with the ability to inhale a sufficient amount of air. An excessive buildup of pressure from air or blood around the collapsed lung can also cause compression of the heart and other lung.
5-2. CHECK FOR SIGNS AND SYMPTOMS OF AN OPEN CHEST WOUND
An open chest wound can be caused by the chest wall being penetrated by a bullet, knife blade, shrapnel, or other object. If you are not sure if the wound has penetrated the chest wall completely, treat the wound as though it were an open chest wound. Some of the signs and symptoms of an open chest wound are given below.
Sucking or hissing sounds coming from chest wound. (When a casualty with an open chest wound breathes, air goes in and out of the wound. This air sometimes causes a "sucking" sound. Because of this distinct sound, an open chest wound is often called a "sucking chest wound.")
Blood coughed up.
Frothy blood. (The air going in and out of an open chest wound causes bubbles in the blood coming from the wound.)
Shortness of breath or difficulty in breathing.
Chest not rising normally when the casualty inhales.
Pain in the shoulder or chest area that increases with breathing.
Bluish tint of lips, inside of mouth, fingertips, or nail beds. (This color change is caused by the decreased amount of oxygen in the blood.)
Signs of shock - Rapid and weak heartbeat.
5-3. LOCATE AND EXPOSE OPEN CHEST WOUND
Expose the area around the open chest wound by removing, cutting, or tearing the clothing covering the wound. If clothing is stuck to the wound, do not try to remove the stuck clothing as this may cause additional pain and injury. Cut or tear around the stuck clothing. Do not try to clean the wound or remove objects from the wound.
Check for entry and exit wounds. Look for a pool of blood under the casualty's back and use your hand to feel for wounds. If there is more than one open chest wound, treat the more serious (largest, heaviest bleeding) wound first.
If you are in a chemical environment, seal and dress the wound(s) without exposing the wound(s).
5-4. SEAL AND DRESS THE OPEN CHEST WOUND
Since air can pass through a dressing, you must seal an open chest wound to stop air from entering the chest and collapsing the lung.
a. Open Field Dressing Wrapper
Tear open one end of the plastic wrapper of a field dressing. Remove the inner packet (the field dressing wrapped in paper) and put it aside. Continue to tear around the edges of the plastic wrapper until a flat surface is created. This plastic wrapper will be used to make an airtight seal which will keep air from entering the chest cavity through the wound. If there is both an entry wound and an exit wound, the plastic wrapper can be torn to make two seals if the wounds are not too large. The edges of the sealing material should extend at least two inches beyond the edges of the wound.
CAUTION: Avoid touching the inside surface of the plastic wrapper. The inner surface will be applied directly to the wound and should be kept as free from contamination as possible.
b. Have Casualty Exhale
Tell the casualty to exhale (breathe out) and hold his breath. This forces some of the air out of the chest wound. The more air that can be forced out of the chest before the wound is sealed, the better the casualty will be able to breathe after the wound is sealed. Have the casualty resume normal breathing after the wound is sealed.
If the casualty is unconscious or cannot hold his breath, place the wrapper over the wound after his chest falls but before it rises.
c. Place Wrapper Over Wound
Place the inside surface of the plastic wrapper (the side without printing) directly over the hole in the chest to seal the wound.
Check the plastic wrapper to ensure that it extends two inches or more beyond the wound edges in all directions. If the wrapper does not have a two-inch margin, it may not form an airtight seal and may even be sucked into the wound. If the wrapper is not large enough or is torn, use foil, a poncho, cellophane, or similar material to form the seal.
d. Tape Wrapper in Place
Tape down three edges of the plastic, usually the top edge and two side edges. This creates a "flutter valve" effect. When the casualty inhales, the plastic is sucked against the wound and air cannot enter the wound. When the casualty exhales, air may be able to exit the wound through the untaped (bottom) edge of the plastic.
Caution: If the securing material is not taped down, it must be held in place until the dressing is applied. If the casualty is able, he can hold the sealing material in place. Otherwise, you must keep the sealing material in place while preparing to dress the wound (see Figure 5-1B).
FIGURE 5-1. SEALING AND DRESSING AN OPEN CHEST WOUND
e. Apply Field Dressing
Remove the field dressing from the paper wrapper.
Place the white side of the dressing directly over the plastic wrapper. Maintain pressure on the dressing so the plastic wrapper will not slip.
If an object is protruding from the chest wound, do not try to remove it. Place airtight material around the object to form as airtight a seal as possible. Stabilize the object by placing a bulky dressing made from the cleanest material available around the object. Apply improvised bandages to hold the sealing material and dressings in place. Do not wrap the bandages around the protruding object.
f. Secure Dressing
Secure the field dressing using the attached bandage. The field dressing must be tight enough to ensure that the plastic wrapper (or other sealing material) will not slip. If the casualty is able, have him hold the dressing in place while you secure it. If he cannot help, then you must hold the dressing in place while securing it.
Grasp one tail, slide it under the casualty, and bring it back over the dressing.
Wrap the other tail around the casualty in the opposite direction and bring it back over the dressing.
Tighten the tails and tie them with a nonslip knot over the center of the dressing. The knot will provide additional pressure over the wound and will help to keep the seal airtight. The field dressing should not interfere with breathing.
CAUTION: If an object is protruding from the wound, tie the knot beside the object, not on it.
If you are not able to tape the sealing material (plastic wrapper) in place and the sealing material slips while the dressing is being applied or secured, the airtight seal may be lost. Remove the dressing and sealing material, reseal the wound, replace the dressing, and secure the dressing.
g. Seal and Dress Other Open Chest Wounds
If there is more than one open chest wound, seal and dress the other wound(s). If needed, improvise dressing from the cleanest material available and use a bandage torn from a shirt or other material to keep the sealing material and dressing in place.
5-5. POSITION A CASUALTY WITH AN OPEN CHEST WOUND
Position the casualty on his side with his injured side next to the ground. Pressure from contact with the ground acts somewhat like a splint to the injured side and helps to reduce pain. (Positioning the casualty on his uninjured side might cause a worsening of his condition.)
FIGURE 5-2. CASUALTY WITH DRESSED OPEN CHEST WOUND
The casualty may wish to sit up. If he can breathe easier when sitting up than lying on his side, allow him to sit up with his back leaning against a tree, wall, or other support. If he becomes tired, have him lie on his injured side again.
5-6. MONITOR A CASUALTY WITH AN OPEN CHEST WOUND
Seek medical help. If possible, send someone else after help while you stay with the casualty.
Monitor the casualty's breathing. Perform mouth-to-mouth resuscitation, if needed.
Treat for shock.
Evacuate the casualty as soon as practical.
Air may still enter the chest cavity even if the wound is sealed and dressed. The air can cause a life-threatening condition called tension pneumothorax.
If the casualty's condition worsens (increased difficulty in breathing, shortness of breath, bluish tint to skin, etc.), lift the sealing material from the wound to let the air escape and then reseal the wound. Taping the plastic wrapper (flutter valve effect) helps to prevent tension pneumothorax.
If possible, practice applying an airtight seal and field dressing to a simulated casualty. Have another person score your performance using a performance checklist.