LESSON 8
PERFORM FIRST AID FOR AN OPEN CHEST WOUND
(TASK 081-831-1026)

TASK:

Identify procedures for performing first aid on a casualty with an open chest wound.

CONDITION:

Given multiple-choice examination items pertaining to chest wounds.

STANDARD:

Score 70 or more points on a 100-point comprehensive examination.

REFERENCES:

STP 21-1-SMCT, Soldier's Manual of Common Tasks: Skill Level 1.
FM 21-11, First Aid for Soldiers.

NOTE: Some of the task titles and information have changed and are not reflected in FM 21-11 and STP 21-1-SMCT. Refer to the Army Training Support Center, Common Core Task internet site at: http://www.atsc.army.mil/dld/comcor/comcore.htm for up-to-date task information.

8-1. INTRODUCTION

FIGURE 8-1. EFFECTS OF AN OPEN CHEST WOUND

The body has two lungs. Each lung is enclosed in an airtight area within the chest. If an object punctures the chest wall and allows air to get into this area, the lung begins to collapse (not expand fully). In order for both lungs to collapse, both sides of the chest would have to be punctured. Figure 8-1 depicts a lung completely collapsed, but the lung of the casualty you treat may not be completely collapsed. Any degree of collapse, however, interferes with the casualty's ability to inhale a sufficient amount of air.

8-2. IDENTIFY 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 a chest 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 sound 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.")

Frothy blood. (The air going in and out of an open chest wound causes bubbles in the blood coming from the wound.)

Pain in the shoulder or chest area which increases with breathing.

Shortness of breath or other difficulty in breathing.

Chest not rising normally when the casualty inhales.

Blood coughed up.

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.

8-3. SEAL AND DRESS AN 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.

Locate Chest Wound(s)

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.

Expose the 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.

Open Field Dressing Wrapper

Tear open one end of the plastic wrapper of the casualty's 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.

Have Casualty Exhale

Tell the casualty to exhale (breathe out) as much as possible 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.

If the casualty is unconscious or cannot hold his breath, watch his chest. Place the wrapper over the wound after his chest falls but before it rises.

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 airtight seal.

Apply Casualty's Field Dressing

Remove the field dressing from the paper wrapper and prepare it for use. If the casualty is able, he can hold the plastic wrapper (or other sealing material) in place while you prepare the field dressing for use. If the casualty cannot help you, then you must keep the sealing material in place while you are preparing to dress the wound.

Place the white side of the dressing directly over the plastic wrapper. Maintain pressure on the dressing so that the plastic wrapper will not slip. Once the dressing is in place, the casualty can resume breathing normally.

Secure Dressing

Secure the field dressing using the attached bandages. 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 you, then you must hold the dressing in place while securing it.

FIGURE 8-2. SEALING AND DRESSING AN OPEN CHEST WOUND

Grasp one tail, slide it under and around 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.

Tell the casualty to exhale and hold his breath. If the casualty is unconscious or cannot hold his breath, tie the knot after his chest falls and before the chest rises.

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.

Have the casualty resume normal breathing.

Seal and Dress Other Open Chest Wounds

If there is more than one open chest wound (an entry and exit wound, for example), seal and dress the other wound(s). Improvise the dressing from the cleanest material available and use a bandage torn from a shirt or other material to keep the airtight seal and dressing in place.

Apply Manual Pressure

If practical, apply direct manual pressure over the dressing for five to ten minutes. The pressure caused by your hand will help to control the bleeding.

8-4. POSITION A CASUALTY WITH AN OPEN CHEST WOUND

FIGURE 8-3. CASUALTY WITH DRESSED OPEN CHEST WOUND

Have the casualty lie on his side with the injured side next to the ground. This position places additional pressure on the injured side and acts somewhat like a splint. This "splinting" action helps to reduce pain. If the casualty were to lie on his uninjured side, the pressure would hamper his breathing.

The casualty may wish to sit up. If he can breathe easier when sitting up than when lying on his side, allow him to sit up with his back leaning against a tree, wall, or other support. If he tires of sitting up, have him lie on his injured side again.

8-5. 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. Rescue breathing may be needed.

Evacuate the casualty as soon as practical.