9 Guidelines For Treating An Open Chest Wound

Chest injuries account for 25% of all trauma-related deaths. An open chest wound, also known as a sucking chest wound, is an injury that may cause a hole in the chest because of a gunshot, stabbing, or any other cause resulting in a new air passage into the chest cavity. An open chest wound is considered when it’s bigger or has the same size as two-thirds the diameter of the windpipe. 

Breathing in and out allows air through the hole in the chest leading to pneumothorax; collapsing of the lungs. Treatment for this condition would require decompression using a needle, i.e., letting out the air held within the pleural cavity by inserting an 8cm needle perpendicular to the chest wall. Tube thoracostomy can also be performed.

Treating an open chest wound requires ensuring that air doesn’t go in and letting excess air out. It’s advisable to assume that a penetrating injury to the chest is sucking air, whether there’s a hissing sound or not. You can find more information with regards to treating an open chest wound from various sites. Read through this article to learn more. 

Signs And Symptoms

• A hole in the chest as big as a coin
• Difficulty in breathing
• Rapid and shallow breathing
• Coughing up blood
• Fast heart rate
• The affected side of the chest doesn’t have any breathing sounds
• Gushing of blood around the wound when the patient breathes
• Pain
• Chest trauma
• Interference with mental status as a result of less oxygen
• Soft tissue crepitus; is a condition in which respiration pressure pushes air into the subcutaneous tissue of the chest, causing a crackling feeling. 

Treatment

• Call For Help

Call 911 for emergency medical help with any severe chest wound. Sometimes the injury may not show externally, but the patient could be injured internally. Call for help anyway. Carefully follow the instructions provided by the operator. If there’s no response from 911, rush the patient to the hospital for emergency attendance as quickly as possible.

• Keep Safe

Always keep safe whenever you’re helping out by adhering to universal precautions. Wear gloves as you help out with your hands. Remove any clothing or objects covering the wound except for that which may be stuck to the wound. 

• Take Proper Care Of The Wound

Ensure that you cover the wound while preparing the dressing, either with your hand that has a glove, another person’s hand, or the patient’s hand if they are stable enough and in case there’s nobody around to help. 

• Start Cardiopulmonary Resuscitation (CPR)

Have the patient in a half-seated position and slightly leaning on the wounded side to enhance the functioning of the other lung. Start CPR if the patient isn’t breathing or is gasping for air. There’s CPR that’s specific for children and adults. Keep the injured person warm by covering them with a blanket, and also have them not eat or drink anything as you do first aid.

• Provide Oxygen

If necessary, assess the condition and the patient’s needs and provide the patient with a non-rebreather mask. This mask helps in stabilizing the lungs of the patient, making sure that they can have enough oxygen.

• Cover The Wound

Put a clean plastic covering over the hole about two inches beyond the wound and hold it down in place with tape on three sides. You can use a chest seal, and if you don’t have one, the plastic that covers sterile dressings can be used. It’s advisable not to pull out any objects pierced through the chest. This may cause severe bleeding and make it harder for a medical practitioner to determine how severe the injury is. Instead, shorten the outer part of the external object and make it stable with several layers of massive pads. 

• Control The Bleeding

Put some pressure over the covering/seal to stop the bleeding. If the covering/seal is soaked in blood, put another one on top of it to help control the bleeding.

• Look Out For A Collapsed Lung

Look out for signs of a collapsed lung, also known as pneumothorax. Pressure begins to build up when the collapsed lung lets out a lot of air between the chest wall and the lung. Increased pressure buildup causes very low blood pressure, also known as shock, which may eventually cause death. Other pneumothorax signs are:

• Acute shortness of breath
• One side has no lung sound
• One side appears bigger than the other
• The lips, neck, or fingers appear blue; a condition referred to as cyanosis.
• Swelling of the veins on the neck.

If all signs point to the presence of pneumothorax, remove the covering/seal to release air. It may be challenging to detect pneumothorax if you haven’t been trained.

• Monitor The Progress Of The Patient

Once the patient arrives at the emergency department, they’ll be assessed and helped to get back to balance. If the patient loses a lot of blood, blood transfusion is critical. Serious chest injuries are better treated through surgery. Other activities carried out when the patient arrives at the hospital are:

• Placing a facemask over the nose and mouth of the patient to get oxygen.
• An intravenous (IV) is connected and the patient is given anesthesia ready to be operated on by a doctor.
• In the process of surgery, the doctor cuts through the patient’s chest to provide a small entry for a temporary chest tube to drain fluids and release air around the lungs. 
• The doctor then closes up the wound with stitches to stop any bleeding and prevent the passage of air into the pleural space.

There could be complications resulting from the open chest wound that may cause death like:

• Hypoxia is the loss of oxygen in the blood
• The buildup of fluid in the chest cavity
• Tension pneumothorax
• Severe injury to critical organs like the gastrointestinal system, heart, and lungs

Final Thoughts

Chest injuries are likely to occur in conflict and crises and can be deadly. The most crucial step to take in treating an open chest wound is to obtain professional emergency medical assistance. Then ensure to cover the chest cavity by creating an outlet to prevent the outside air from exerting pressure on the lungs while still releasing air as the lungs expand. Following these guidelines can help you in treating open chest wounds.