First aid for chest wounds

Classification and signs of chest wounds

Chest wounds are broadly divided into two categories: penetrating and non-penetrating. In non-penetrating injuries, predominantly soft tissues and, less commonly, the rib cage are damaged; they belong to the category of mild injuries. Penetrating wounds (with or without damage to intrathoracic organs) are extremely life-threatening.

A serious injury can be suspected by the characteristic clinical presentation:

• The skin becomes pale and acquires a bluish tint.
• Intense pain occurs, which sharply increases when trying to take a deep breath. It is often so severe that it forces the patient to immediately sit down or lean towards the wound, pressing it tightly with their hand.
• Dyspnea, a feeling of tightness in the chest, cough, and in some cases hemoptysis are observed.
• Breathing and pulse become accelerated.
• Visual asymmetry of respiratory movements is noticeable: the injured side clearly lags behind on inspiration.

Features of traumatic pneumothorax

One of the most formidable consequences of a penetrating wound is open pneumothorax. It occurs when the integrity of the chest wall and parietal pleura is violated. As a result, the pleural cavity gets direct communication with atmospheric air.

Open pneumothorax can be recognized by specific local signs. Foamy blood is noisily released from the wound, and air is sucked in with a whistle with every breath. On expiration, air bubbles may be released from the wound tract. In addition, subcutaneous emphysema (air concentrated in the tissues) is often detected around the damage zone.

General first aid algorithm

You need to act clearly and consistently in case of a chest injury:

1. Assess the situation and ensure that it is safe to provide aid.
2. If arterial bleeding is present, stop it immediately.
3. Call an ambulance crew.
4. Give the victim a semi-sitting position — this will significantly ease respiratory function.
5. If rib fracture is suspected, apply a adhesive tape tiled bandage. It will fix the bone fragments in a stable position, allowing them to safely participate in the act of breathing.
6. If a foreign body is present in the wound, its removal is strictly prohibited. The object must be fixed with adhesive tape or a bandage in a stable position.
7. Continuously monitor the patient's condition until specialists arrive.

Technique for applying an occlusive dressing

The main goal of first aid in a penetrating chest wound with an open pneumothorax is to stop the communication of the pleural cavity with the external environment (achieve sealing). For this purpose, an occlusive (sealing) dressing is used.

Step-by-step technique (using an individual dressing package — IDP):

• Carefully treat the edges of the wound with an iodine solution.
• Take the rubberized shell of the package and apply it to the wound with the internal sterile side facing down.
• Place cotton-gauze pads over the hermetic shell.
• Bandage the entire structure tightly to the chest.

Such a multi-layer dressing securely closes the defect and does not let air through.

Class and exam questions

What else to study on this topic

• Etiology and pathogenesis of pneumothorax syndrome (bullous emphysema, abscesses, cavities).
• Specific triad of symptoms in spontaneous pneumothorax.
• Complications of prolonged paroxysmal cough: pneumomediastinum and barotrauma.
• Diagnostic significance of chest pain in respiratory diseases.
• Algorithm for differential diagnosis of pulmonary pathology by the nature of the pain syndrome.

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Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.