How to Treat an Open Chest Wound with Occlusive Dressings

Learning how to treat an open chest wound is an extremely important part of emergency medical technician (EMT) and paramedic training because of the threat to life that it poses. While it's not reasonable to expect laypeople to do the interventions carried out by medics, it could prove helpful for them to at least have an idea of what needs to be done in open chest wound treatment and what part they might be able to play if they're ever found in a situation in which the arrival of help might be delayed.

Combatting Pneumothorax and Tension Pneumothorax in Open Chest Wound Treatment

Few people realize that there's a delicate balance of pressure that exists within the chest that can easily be upset when air from the outside enters the cavity (pneumothorax). The threat of a lung collapsing quickly develops. Tension pneumothorax refers to the inability of that outside air to escape. Stabbings and gunshot wounds to the chest are examples of injuries that can lead to these and other conditions such as hemothorax or the filling of the chest cavity with blood and hemopneumothorax which refers to both air and blood filling it. Details of the medical problems that follow if these conditions are treated are beyond this article; however, the danger of a lung collapsing should be enough to alarm someone whether they have medical training or not.

What Is an Occlusive Dressing?

Occlusive dressings are those which form an air tight seal over a wound. Thick plastic and heavy aluminum foil can be used to create them if commercial ones aren't available. Open chest wound treatment includes instructing a conscious patient to exhale while the dressing is being applied. Generally, what's known as a one-way, or flutter-valve dressing is created by taping the dressing on three of its four sides. When the victim inhales, outside air is prevented from entering the chest cavity as the dressing is sucked next to the surface of the wound. When he exhales, air that's trapped inside can escape through the one side that wasn't taped down, helping to prevent the development of tension pneumothorax. The side that wasn't taped down is the valve. The escape of air through the valve should actually be audible which is a very good sign that it is working properly.

The simple application of an occlusive dressing doesn't automatically eliminate all life threats associated with open chest wound treatment because blood and other fluids can accumulate under it and interfere with air being able to escape through the valve. The dressing would need to be gently removed, the area wiped or dabbed clean, and resealed.

What Can You Do to Help Someone While Waiting for Help to Arrive?

It's a very good idea to keep clean protective gloves within reach in case you want to help someone. You always want to protect yourself from exposure. It's not likely you're going to keep commercial occlusive dressings in your car or home, but remembering the other materials that can be used to create a make-shift one is very valuable. Keep in mind that the plastic must be thick enough to work; the use of sandwich wrap will probably prove useless even if you fold it over and over, but it's worth a try if nothing else is available. Be careful with aluminum foil if you have to use it as the edges could further injure tissues.

There is something that you can do that is even more simple than applying an occlusive dressing to help save someone. That is immediately covering the wound with your gloved hand because you don't want air entering the chest cavity even while looking for an occlusive dressing and waiting on the medics to arrive.
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Source:

My EMT training and experience (NREMT certification and state licensed)