Unformatted text preview: Combat Life Saver
APPLY A DRESSING TO AN OPEN
CHEST WOUND Compiled and edited by,
2LT John C. Miller, PA-C Lesson 5
APPLY A DRESSING TO AN OPEN
If an object punctures the chest wall, permitting air to
enter between the chest wall and the lung, the lung
collapses. Any degree of collapse, interferes with the
body's ability to expand the lung and absorb oxygen.
Even if one lung is collapsing, the other lung may be
functioning, assuming that side of the chest is intact.
The first aid procedure for a casualty with a
penetrating chest wound is to prevent the lung from
collapsing any more than it has already by placing an
airtight seal over the wound.
airtight APPLY A DRESSING TO AN OPEN
Apply a dressing to a casualty with an open chest
Given a simulated casualty with an open chest
wound and needed supplies.
Score a GO on the performance checklist. CHECK FOR SIGNS AND SYMPTOMS OF AN
OPEN CHEST WOUND
• Obvious penetration of the chest wall by a bullet,
knife blade, shrapnel, or other object.
• Sucking sound coming from chest wound. (An open
chest wound is often called a "sucking chest wound.")
• Frothy blood from chest wound. (Bubbles of blood
are caused by air going in and out of the wound.)
• Blood coughed up.
• Shortness of breath or other difficulty in breathing.
• Chest not rising normally when the casualty inhales.
• Pain in the shoulder or chest area which increases
with CHECK FOR SIGNS AND SYMPTOMS OF AN
OPEN CHEST WOUND
• Bluish tint to lips, inside of mouth, fingertips, or
nailbeds. (The color change is caused by the
decreased amount of oxygen in the blood.)
• Rapid and weak heartbeat.
When in doubt, treat the wound as an open chest wound. LOCATE AND EXPOSE OPEN CHEST WOUND
• Check for entry and exit wounds.
• Expose the area around the open chest wound by
removing, cutting, or tearing the clothing covering the
If clothing is stuck to the wound, cut or tear around the stuck
clothing rather than removing the stuck clothing.
Do not try to clean the wound or remove impaled objects.
If you are in a chemical environment, seal and dress the
wound without exposing the wound, other than the exposure
needed to seal the wound.
needed LOCATE AND EXPOSE OPEN CHEST WOUND
• 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.
more SEAL AND DRESS THE OPEN CHEST
• 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.
• Open Field Dressing Wrapper
• Tear open one end of the plastic wrapper of a field
• Remove the inner packet.
• Tear around the edges of the plastic wrapper until a
flat surface is formed. Do not touch the inside surface
of the plastic wrapper.
of SEAL AND DRESS THE OPEN CHEST
• Seal the Wound
• Tell the casualty to completely exhale and hold his
breath. If possible, the casualty should hold his
breath until the sealing material has been secured.
Having the casualty to exhale forces some of the air
out of the chest wound.
If the casualty is unconscious or cannot hold his breath,
place the wrapper over the wound after his chest falls but
before it rises.
before SEAL AND DRESS THE OPEN CHEST
• Place the inside surface of the plastic wrapper (the
side without printing) directly over the wound. The
plastic wrapper makes an airtight seal which keeps
air from entering the chest cavity through the wound.
Breathing can be resumed.
If the edges of the wrapper do not extend at least two inches
beyond the edges of the wound, it may not form an airtight
seal and may even be sucked into the wound. If the wrapper
is too small, use foil, a poncho, cellophane, or similar
material as the seal.
If an object is protruding from the chest wound, place airtight
material around the object and stabilize the object with
clean, bulky material and bandage. Do not wrap the
bandages around the object.
bandages SEAL AND DRESS THE OPEN CHEST
• Tape the top and both sides of the plastic wrapper to
the casualty's chest. Leave the bottom edge untaped
to form a flutter-type valve to allow air to escape
through the chest wound, but keep air from entering
the chest wound.
• Apply the Field Dressing
• Remove the field dressing from the paper wrapper.
• Open the field dressing and place the white pad
directly over the plastic wrapper.
directly SEAL AND DRESS THE OPEN CHEST
• Hold the dressing in place with one hand or have the
casualty hold the dressing in place while you secure
• Grasp one tail, slide it under the casualty, and bring it
back over the dressing.
back SEAL AND DRESS THE OPEN CHEST
• 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 when the casualty exhales.
The bandages should keep the dressing and sealing
material from slipping, but should not interfere with
breathing. SEAL AND DRESS THE OPEN CHEST
If the casualty is unconscious, tie the knot after his chest
If an object is protruding from the wound, tie the knot beside
the object, not on it.
If the sealing material slips while the dressing is being
applied or secured, repeat the procedures.
applied • Seal and Dress Other Open Chest Wounds
• If both an entry wound and an exit wound are
present, both wounds must be sealed in order to stop
the collapse of the lung.
the SEAL AND DRESS THE OPEN CHEST
• Apply Manual Pressure
• Apply direct manual pressure over the dressing for 5
to 10 minutes to help control bleeding.
The casualty can apply the pressure if he is able. POSITION A CASUALTY WITH AN OPEN
• Position the casualty on his side with the injured side
next to the ground. (If the casualty were to lie on his
uninjured side, his uninjured lung would not expand
• If the casualty can breathe easier when sitting up,
allow him to sit with his back against a tree or other
support. MONITOR A CASUALTY WITH AN OPEN
• Treat the casualty for shock.
Evacuate the casualty as soon as possible.
If the casualty has increased difficulty in breathing,
shortness of breath, or bluish tint to skin, quickly lift
the sealing material from the wound, let the air
escape with complete expiration, and reseal the
wound APPLY A DRESSING TO AN OPEN
Once the casualty reaches a medical treatment
facility, medical personnel can remove trapped air
from the casualty's chest and make the lung fully
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- Fall '11
- Pneumothorax, shortness of breath, chest wound