A sucking chest wound is a life-threatening injury that occurs when an open wound in the chest allows air to enter the space between the lungs and chest wall and causes the lung to collapse. Most commonly, this occurs due to gunshot wounds, stabbing injuries, or blunt trauma, but it requires all the immediacy possible in terms of medical attention. In the U.S., approximately 60% of penetrating chest injuries are caused by violent trauma.
Without prompt treatment, a sucking chest wound can lead to respiratory failure. Thus, you must recognize the signs, such as the hissing sound from the wound or difficulty breathing. Now, as a first responder, how would you treat the condition? Read on to find out!
What Is A Sucking Chest Wound?
Your lungs are made up of delicate sacs that fill with air when you inhale air. Your chest activity, including your ribs, protects your lungs and maintains an open space for them to expand. When a sharp object pierces your chest cavity, it might lead to a sucking chest wound.
A sucking chest wound, also called open pneumothorax, happens due to penetrating chest trauma which will create an air passage from the environment into the thoracic activity. Depending on the size or severity of the wound, air will enter into the pleural space, resulting in collapsed lungs.
A collapsed lung will leave you gasping or sucking for air as your lung fights against the increased pressure entering through the wound. If air enters the thoracic cavity but is prevented from exiting (through the tissue valve effect), it will lead to the rapid development of tension pneumothorax.
How Does Sucking Chest Wound Occur?
Sucking chest wounds occurs when there is a forceful impact with a dull object or a piercing impact from a sharp object. Such blunt or penetrating trauma happens in situations such as car crashes or physical attacks. When the hole in the chest wall reaches 66% of the width of the trachea, a sucking chest wound can form. These causes are discussed in detail as follows:
Blunt Trauma
Blunt trauma occurs when a force or impact is applied to the body, but the skin or underlying tissues are not punctured. The damage usually results from a collision or strike that doesn’t involve sharp objects. Common causes include falls, motor vehicle accidents, sports injuries, or assaults.
Penetrating Trauma
Penetrating trauma occurs when an object pierces the skin or enters the body, often causing damage to internal organs or structures. This type of injury is commonly caused by sharp objects such as knives, bullets, or other foreign objects. It can lead to significant bleeding and life-threatening internal damage depending on the depth and location of the injury.
Diagnosis and Treatment
In certain circumstances, sucking chest wounds might also be caused during diagnosis or treatment by a medical professional. For instance, a healthcare professional might injure your chest wall unintentionally during a transtracheal aspiration when inserting a needle into the lung tissue.
First Aid for Sucking Chest Wound
If a sharp or blunt object is still protruding from the sucking chest wound, you should not remove it. It will make the victim’s injury worse by increasing the risk of hemorrhage, potential infection, or damage to tissue. Instead, you can connect with your local emergency services and follow the steps that the emergency services operator provides you. If you cannot contact them, you can readily get the injured person to the nearest healthcare facility as soon as possible. In such circumstances, you should also follow the proper first aid procedures as below.
Step 1. Prepare for First Aid
Before providing care, ensure your hands are clean to reduce the risk of infection. Wash your hands thoroughly with soap and water if available, then wear clean gloves to protect both yourself and the victim.
Step 2. Expose the Wound
If the wound is covered by loose clothing or debris, carefully remove those items to expose the injury. However, do not attempt to remove clothing that is stuck to the wound, as this can worsen bleeding or cause further damage.
Step 3. Cover the Wound Immediately
Place one of your hands directly over the wound to prevent air from entering the chest cavity. If others are present, ask someone else to apply pressure so you can prepare a proper dressing. If you are alone, instruct the victim (if conscious and able) to place their hand over the wound until you can secure it.
Step 4. Seal the Wound
You can use a chest seal or sterile, medical-grade plastic or tape to seal the chest wound. If you cannot find any of them, you can even use a clean Ziploc bag to cover the wound. In case there are no other options, you can use your hands.
If the victim is conscious, ask them to breathe out to release any excess air. Keep the chest seal over the hole in the chest that is sucking in air into the wound, be it entry or exit wounds. Ensure no air enters the wound.
Step 5. Apply an Occlusive Dressing
Now, secure the seal using the occlusive dressing method to create an airtight seal. An occlusive dressing is a special type of bandage used to seal a chest wound in situations like a sucking chest wound. The seal should have at least one open side to let out the air without the entry point. The dressing is then placed directly over the wound. It should be large enough to cover the entire wound, with some overlap onto the surrounding skin to form a tight seal.
Step 6. Monitor for Tension Pneumothorax
In some cases, air may continue to build up inside the chest, leading to a serious condition known as tension pneumothorax. This can cause the lung to collapse, placing pressure on the heart and other vital organs. Watch for key warning signs such as:
- Cracking or bubbling sounds when the victim breathes
- Bluish tint to the lips or fingers
- Swollen neck veins
- One side of the chest appears larger than the other
If you notice these signs, carefully remove the chest seal to allow trapped air to escape. Position the victim on their side to make breathing easier and continue monitoring their condition while awaiting medical assistance.
Step 7. Perform CPR if Needed
If the victim becomes unconscious and stops breathing, begin CPR immediately. Start by checking for responsiveness. You can tap their shoulder and speak loudly to see if they respond. If there’s no reaction, begin chest compressions at a rate of 100-120 compressions per minute. If you’re trained in CPR, provide rescue breaths after every 30 compressions. Continue this cycle until the person shows signs of breathing or emergency responders arrive. Acting quickly during this stage can be life-saving.
When performing CPR on someone with a sucking chest wound, be mindful not to apply pressure directly over the injury site. Focus on delivering compressions to the center of the chest (the lower half of the sternum) to avoid worsening the wound or causing additional harm.
Step 8. Additional Care Tips
While waiting for medical help, take steps to improve the victim’s comfort and safety. Cover them with a blanket to prevent shock and keep their body temperature stable. Avoid giving them food or drink, as this can increase the risk of choking or complications. When the wound is actively bleeding, apply gentle pressure to slow the blood flow without disturbing any objects or dressings already in place.
Read More: Crucial Lifesaving Skills: First Aid and CPR Training
How do Doctors treat Sucking Chest Wounds?
Sucking chest wound treatment aims to relieve pressure on the lungs and allow it to re-expand. Doctors treat a sucking chest wound (also known as an open pneumothorax) through a series of immediate and subsequent medical interventions. They prioritize sealing the wound and restoring normal respiratory function. Here are some possible treatment strategies for the condition.
Observation
Not all cases of pneumothorax require invasive intervention. In mild or small pneumothoraces, especially those without significant symptoms, a “watch and wait” approach may be recommended. This is called observation and typically applies when:
- The person has minimal or no symptoms.
- The pneumothorax is small (usually less than 2–3 cm on a chest X-ray).
- There is no underlying lung disease.
- The individual is stable and under close monitoring.
If you are having trouble breathing, you may need oxygen therapy, which can help the lungs heal faster by increasing the reabsorption rate of air. However, avoid activities like flying or scuba diving until full recovery, as changes in air pressure can trigger a recurrence. Always consult a healthcare provider before resuming such activities.
Draining Excess Air
If the damage of the sucking chest wound has severe symptoms, then your healthcare professional might recommend needle aspiration and chest tube aspiration. These significant procedures are performed to remove excess air from the pleural space in the chest. They can be carried out at the bedside without requiring general anesthesia. The procedure includes:
- Needle Aspiration
Needle aspiration involves the insertion of a needle into the cavity in the lungs and extracts the air using a syringe. The procedure restores the normal pleural pressure dynamics, facilitating better ventilation and gas exchange in the lungs, thereby alleviating symptoms like shortness of breath, tachypnea (rapid breathing), and cyanosis (bluish discoloration due to low oxygen levels).
- Chest Tube Aspiration
Chest tube aspiration follows the insertion of the hollowed tube between your ribs, which allows air to drain and inflate the lungs. Your healthcare professional will recommend that the tube remain in place for five days or longer, based on your condition.
Surgery
In severe cases of a sucking chest wound or pneumothorax, your healthcare provider may recommend more invasive procedures to assess and treat the problem.
- Thoracotomy
Thoracotomy is a surgical procedure where your surgeon will make an incision into the pleural space (the area between the lungs and chest wall). It will allow them to directly examine the lungs and address any issues, such as bleeding or air leaks.
- Thoracoscopy
Thoracoscopy, or video-assisted thoracoscopic surgery (VATS), involves inserting a small camera through the chest wall. This less invasive approach allows the surgeon to examine the lung closely and perform repairs without making a large incision.
- Pleurodesis
If the victim experiences recurring episodes of pneumothorax, then the surgeon may recommend surgery. The procedure will repair any weak areas of the lung that allow air to leak out. One such procedure is pleurodesis, where the lung is intentionally made to stick to the chest wall to prevent future air leaks. This process can help to reduce the chances of further pneumothorax episodes.
However, pleurodesis is not routinely recommended for first-time or mild cases due to its potential complications and the fact that it addresses symptoms rather than underlying causes. Possible post-surgical complications include infection, scarring of the lung tissue, chronic pain, and in rare cases, respiratory issues if the lung does not fully re-expand or function normally afterwards. Because of these risks, it is typically reserved for patients with recurrent or persistent issues, where the benefits outweigh the potential side effects.
Read More: A Complete Guide to Cracked Ribs Diagnosis and Treatment
Recovery and Outlook of Sucking Chest Wound
The recovery period from sucking chest wounds vary based on the number and severity of the wounds. If there is just one wound that is not severe, the recovery period will be quick and painless. In case you have multiple wounds or if they are severe, like damage to organs or arteries, the recovery period could take much longer.
Recovery time after illness, injury, or surgery is influenced by several key factors. Here’s a breakdown of the main factors:
Age
Generally, younger people tend to recover faster due to higher cellular repair and regeneration rates. They usually have more robust immune systems and better tissue elasticity. As people age, the recovery process tends to slow down. Older individuals may have decreased muscle mass, slower metabolism, and a weakened immune system, which can lengthen recovery times.
Overall Health
People who are physically fit or maintain an active lifestyle often recover more quickly due to better cardiovascular health, muscle tone, and a more efficient metabolism. Psychological factors such as stress, anxiety, and depression can impair the healing process. Emotional well-being contributes to a quicker recovery, while chronic stress can increase inflammation and slow down recovery.
Presence of Comorbidities
People with conditions like diabetes, heart disease, respiratory disorders, or autoimmune diseases may experience longer recovery times because their bodies have to manage both the recovery process and the underlying disease. For instance:
- Diabetes can impair wound healing and increase the risk of infection.
- Heart disease can limit the body’s ability to circulate blood efficiently, slowing recovery.
- Obesity can complicate healing by putting extra strain on the body and slowing circulation.
Whatever the case, if the victim receives prompt first aid, they can recover relatively quickly. In general, long-time recovery can take up to 6 months or more, as lungs and other damaged organs need time to restore their strength and endurance.
Complications can occur even after successful treatment, and early detection is key to effective management. Continuous monitoring ensures that any issues are identified and addressed promptly, improving the chances of a full recovery and minimizing long-term health risks. Always communicate any changes in symptoms to your healthcare provider and adhere to the recommended follow-up schedule for optimal outcomes.
Manage Sucking Chest Wound Emergencies Effectively!
A sucking chest wound happens when air escapes through a hole in your chest wall because of sudden trauma or severe injury, trapping the air in the chest cavity outside the lungs. The trapped air will exert pressure on your lungs, making them collapse. Even though the condition is life-threatening, With proper training, you can provide prompt first aid and effective advanced treatment. The first-line treatment should include the removal of air, blood, and other fluids from the chest cavity and repairing the chest hole. Such immediate care will reduce the amount of air trapped in the chest cavity and save the victim’s life.
Frequently Asked Questions (FAQs)
- How to treat an open chest wound?
The treatment for an open chest wound depends on the severity or size of the injury. First, call emergency services immediately. Have the victim lie down, and if they are unconscious or feeling light-headed, place a backpack or another object under their head for support. Now, seal the wound with a clean cloth, or pad. If there is bubbling of air or blood from the wound, tape down three sides of the dressing to prevent air from entering so that the victim can breathe more easily.
- How do you treat a penetrating chest wound?
If the victim with a penetrating chest wound is conscious, let them sit upright, leaning towards the injured side to help with their breathing. The hole in the chest should be left open to fresh air, allowing air to escape and preventing tension pneumothorax. Nonetheless, you can apply direct pressure to stop the bleeding without blocking the hold.
- Should you seal a chest wound?
Yes, chest seals are essential in treating penetrating chest wounds. If you suspect a chest injury, apply a chest seal to prevent air from entering the wound and causing pneumothorax, which can be life-threatening. Sealing the wound ensures that air does not enter the chest and collapse the lungs, which could lead to further complications.
- What are the 4 signs and symptoms of a chest wound?
The chest wound accumulates the entry of air between the chest wall and the lungs, which results in pneumothorax. You can recognize the condition with the following signs and symptoms,
- Chest hole or opening can be painful and induce breathing difficulties
- A characteristic sucking sound when the air enters the wound.
- When the pressure inside the chest increases, it will decrease the blood pressure, sometimes resulting in shock.
- You may feel weak and dizzy
- Bulge appearance of veins in the neck
- When caring for a patient with an open chest wound, should you?
When you are responsible for a patient with an open chest wound, your immediate management strategy should involve covering the wound with a rectangular, sterile, occlusive dressing. The dressing will be closed securely with tape, covering three sides. It will prevent atmospheric air from entering the chest wall during inspiration while allowing the exit of intrapleural air during expiration.
