A hole in the chest (gunshot wound, stabbing or other puncture wound) makes a new pathway for air to travel into the chest when it expands. That hole pulling air into the chest cavity is called a sucking chest wound. Sucking chest wounds are dangerous because they lead to collapsed lungs (pneumothorax). Treating a sucking chest wound requires two things: keeping air from going in while letting extra air out.
It can be difficult to identify when a penetrating wound to the chest is sucking air or not, so it's best to assume any penetrating wound to the chest is a sucking chest wound.
Time Required: ASAP
- Stay Safe. If you are not the victim, practice universal precautions and wear personal protective equipment if available.
- Call 911. If the 911 operator gives instructions, follow those instructions and ignore the rest of this page. If 911 is not available, get the victim to emergency medical help as soon as possible.
- Seal the sucking chest wound. Put something plastic (preferably sterile or at least clean) over the hole and tape it down.
Watch for signs of a tension pneumothorax. A tension pneumothorax is a collapsed lung that has leaked lots of air between the chest wall and the lung, building up pressure and pushing the lungs over to the other side of the body. If the pressure builds too much, the victim will develop a dangerously low blood pressure (shock) and likely die.
Signs of a tension pneumothorax include:
- Severe shortness of breath
- Unequal chest (one side looks bigger than the other)
- Veins on the neck bulging (jugular vein distension)
- Blue lips, neck or fingers (cyanosis)
- No lung sounds on one side
- Remove the seal if necessary. If you suspect a tension pneumothorax is building, take off the seal to allow the air to escape.
- Taping the seal on three sides is supposed to allow air to escape while blocking air from sucking in. In my experience that doesn't really work so well. Blood tends to glue the plastic to the wound. Careful observation works much better than improvised chest seals. There are chest seals made specifically for sucking chest wounds, but nothing beats careful observation.
- If you do have to remove a chest seal to relieve a tension pneumothorax, you probably should leave it off. Removing the seal will most likely let the pressure out and equalize the pressure inside the chest with the outside atmosphere. Again, watch the victim closely for signs of tension pneumothorax.
- Recognizing a tension pneumothorax is difficult if you haven't been trained in first aid. If you have a victim of a penetration wound to the chest of any kind -- industrial accident, gunshot wound, stabbing, etc -- the most important step is getting professional emergency medical help. Don't hesitate to call 911 or get the victim to the emergency department as quickly as possible.
Henry, Mark C., and Edward R. Stapleton. EMT Prehospital Care. 3rd Ed. 2004. Mosby/Jems.