Sucking Chest Wound Management

A sucking chest wound or open pneumothorax is a fairly uncommon event off the battlefield, and civilian guidelines as a result are highly dependent on the experience of the military expert opinion concerning their management. Past recommendations were to place a three-sided occlusive dressing to allow air to egress to prevent a tension pneumothorax, but battlefield guidelines calling for an occlusive dressing closed on three of four sides have not proven to be effective or realistic. Covering the wound improves respiratory mechanics, but the three-sided occlusive dressing on bleeding chest wounds is no longer recommended. Current tactical prehospital guidelines recommend a vented chest seal or closing the wound and observing the patient for development of a tension pneumothorax if one is not available. A needle is placed in the chest to release the air if a tension pneumothorax develops.   The Tactical Combat Casualty Care Guidelines recommend a non-vented chest seal if a vented chest seal is not available, and that physicians treat by burping or removing the dressing or by needle decompression if the patient develops increasing hypoxia, respiratory distress, or hypotension, and a tension pneumothorax is suspected. (National Association of Emergency Medical Technicians, Tactical Combat Casualty Care Guidelines, Oct. 28, 2013; http://bit.ly/1pdHwIw.)   The recommendations for a vented chest seal is a change from the 2011 guidelines that recommended immediate application ...
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