"Sucking Chest Wound Treatment" (Pre-Hospital)

Sucking Chest Wound

A sucking chest wound (SCW) happens when an injury causes a hole to open in the chest. Sucking chest wounds are often caused by stabbing, gunshots, or other injuries that penetrate the chest. 

Signs of a SCW include: an opening in the chest about the size of a coin, hissing or sucking sounds when the patient inhales and exhales, obvious bleeding from the site of the wound, bright red or pink colored foamy blood at or around the wound site, coughing up blood, and labored or difficulty breathing.

A sucking chest wound is life-threatening and should be treated as a medical emergency. The SCW is life-threatening because they often compromise the integrity of the Pleural Space which is the cavity that exists underneath the chest wall and houses the lungs. The pleural space is a fluid filled cavity that maintains a negative pressure keeping the lungs from collapsing. If the pleural space is compromised by an injury like a sucking chest wound, the negative pressure will become atmospheric causing the lungs to collapse. A collapsed lung can cause major complications and greatly decrease the ability to breath directly effecting how much oxygen is delivered to the body. 

If a sucking chest wound has compromised the pleural space and goes untreated, it could lead to a fatal condition known as tension pneumothorax.

Tension Pneumothorax

A tension pneumothorax is a life-threatening condition that develops when air is trapped in the pleural space/cavity under positive pressure. This positive pressure will result in the displacement of internal structures/organs and compromise cardiopulmonary function resulting in death. 

Signs of Tension Pneumothorax include: sharp chest pain, labored breathing, shortness of breath, rapid breathing, altered mental state, jugular vein distention, and tracheal deviation.

If any of these signs are present with a SCW then reassessment of dressings and further treatment should be done immediately.

Treatment (SCW)

To treat a sucking chest wound first ensure that the area is safe and any immediate threats have been dealt with. Then make sure there are no more immediately life threatening injuries like massive hemorrhage or blocked airway. Once these concerns are managed, you can begin the treatment process of a SCW.

- Step 1: Don PPE (personal protective equipment)  

- Step 2: Expose the wound site and identify the injury. Remove any clothing or equipment that may be blocking treatment. DO NOT remove any objects that are penetrating the body or stuck to the wound. 

- Step 3: Control any bleeding with direct pressure over the wound site.

- Step 4: wipe and clear away any blood, fluid, or debris from the wound site. 

- Step 5: With a sterile occlusive dressing / chest seal, apply directly over the penetration at the peak of patient exhalation. If using a vented chest seal, apply the vent / valve centered over the penetration.

- Step 6: Log roll the patient to inspect for exit wounds or additional penetrations. If an additional penetration is found repeat steps 2 through 5. 

- Step 7: Position conscious patients in the position they are most comfortable in and position unconscious patients in the recovery position with the affected / injured side down towards the ground. 

- Step 8: Reassess often (2 - 5 minutes).

If any signs and symptoms of tension pneumothorax are noticed, reassess the dressing and ensure that it is properly sealed. If signs continue, proceed with "burping" the wound.

SCW "Burping" 

- Step 1: Peel back the chest seal enough to expose the penetration.

- Step 2: Wipe and clear away any obvious blockage and debris.

- Step 3: Reapply the chest seal with intentional downward pressure at the peak of patients exhalation.

A sucking chest wound is a trauma medicine emergency and you must try to get affected patients to professional  emergency care as soon as possible.  

 Conclusion 

Sucking chest wounds are inherent in gunfighting injuries and their treatment and management should be confidently understood by anyone who may find themselves in any possible gunfights. 

For more information and a visual explanation of sucking chest wounds and the appropriate treatment please watch our video.