Civilian Trauma Response

MANAGING AN OPEN PNEUMOTHORAX

Research indicates that an open pneumothorax (sucking chest wound) can be treated effectively with an occlusive chest seal.[11] If an open chest wound is not treated correctly, it can develop into a life threatening tension pneumothorax.

An open pneumothorax occurs when the chest wall injury extends through the parietal pleura into the pleural cavity. This creates two openings that allow air into the thorax. During inspiration, air enters the chest through both openings (chest wall and trachea). However, the only way air can enter the alveoli is from the trachea and bronchioles. The extra opening in the chest wall greatly decreases the volume of air available to the alveoli.

Chest seals work by closing the chest wall opening, allowing air to enter the chest through its normal pulmonary route. Traditional three-sided dressings have shown to be ineffective in preventing conversion of an open pneumothorax to a tension pneumothorax.[11] Vented chest seals allow for the release of accumulated air or evacuation of blood and are effective in preventing the re-entry of air through the open chest wound. Non-vented chest seals adhere to the chest, creating a tight seal and do not allow air to escape or re-enter.

There are many commercial chest seals available on the market. They provide an effective rugged adherence property that allows them to stay in place in the presence of sweat, soil, air, or blood.

COTCCC GUIDELINES AND THE CHEST SEAL

Development of a tension pneumothorax is a common life threatening complication of an open chest wound. All open chest wounds should be treated by immediate application of a vented chest seal to cover the defect. If a vented chest seal is not available, use a non-vented chest seal.

Monitor the patient for the potential complication of a tension pneumothorax. If the patient develops increasing hypoxia, respiratory distress, or hypotension due to a tension pneumothorax, treat by removing or "burping" the dressing or by performing a needle decompression.

In summary, EMS professionals must realize the value of military research and incorporate the latest evidence-based practice regarding the use of tourniquets and chest seals. As the potential for domestic combat injuries remains high, prehospital professionals must focus on those preventable causes of combat death and implement the latest guidelines to improve patient outcome.