A penetrating chest trauma is one of the most urgent emergencies a first responder or prepared civilian can face. Whether caused by a gunshot, stabbing, or other sharp object, an open chest wound can rapidly become life-threatening.
The immediate priority is to seal a chest wound to prevent a dangerous condition known as a sucking chest wound. This guide provides a clear, step-by-step breakdown of chest seal application, an essential component of open chest wound first aid.
Understanding the Critical Need for a Chest Seal
When the chest wall is penetrated, air can enter the pleural cavity, the space between the lung and the chest wall, with each breath. This disrupts the vacuum that allows your lungs to inflate properly. An open chest wound often makes a distinct sucking sound as air moves in and out, hence the term sucking chest wound.
If left unsealed, this can lead to a tension pneumothorax. This occurs when air accumulates in the pleural space with no escape, building pressure. This pressure collapses the lung and can push the heart and major blood vessels to the side, causing cardiac arrest. Proper penetrating chest trauma treatment focuses on preventing this escalation by using an occlusive dressing for the chest wound.
Types of Chest Seals: Vented vs. Non-Vented
Modern field medical kit chest seal options typically come in two varieties, and knowing the difference is crucial:
-
Vented Chest Seal: This type incorporates a one-way valve, often a flutter valve or a built-in channel. It allows air and blood to escape from the wound during exhalation but prevents new air from being sucked in during inhalation. This venting action helps reduce the risk of developing a tension pneumothorax.
-
Non-Vented Chest Seal: This is a fully adhesive occlusive dressing that creates a complete seal over the wound. While effective at stopping air entry, it requires careful monitoring. If the patient develops signs of a tension pneumothorax (severe shortness of breath, tracheal deviation, distended neck veins), the seal must be lifted momentarily to "burp" or vent the trapped air before resealing.
For most first responder scenarios, a vented chest seal is the preferred and simpler option as it manages the risk proactively.
Step-by-Step: How to Apply a Chest Seal?
Follow these steps for effective open chest wound care. Always prioritize your own safety and wear personal protective equipment if available.
Step 1: Scene Safety and Patient Assessment
Ensure the scene is safe for you to intervene. Quickly expose the entire chest area by cutting away clothing. Look for the source of bleeding and identify any exit wounds. Remember, you must check both the front and back of the patient.
Step 2: Call for Help
Activate emergency medical services (EMS) immediately. Penetrating chest trauma treatment requires advanced surgical care.
Step 3: Manage Immediate Life Threats
If there is severe, life-threatening bleeding from the wound, apply direct pressure with a dressing and your hands to control it before proceeding to seal the wound.
Step 4: Prepare the Wound Site
Quickly wipe away any excessive blood, dirt, or debris from the skin surrounding the wound. The goal is to create a relatively dry surface for the adhesive occlusive dressing to stick. Do not spend excessive time cleaning; a good seal can often be achieved even over slightly bloody skin. Do not probe the wound or attempt to remove an impaled object.
Step 5: Apply the Chest Seal
Tear open the packaging of your chest seal. Remove the backing from the adhesive occlusive dressing. For a sucking chest wound, the key is to apply the seal as the patient exhales. If possible, instruct them to "take a deep breath and blow it all out." As they exhale, firmly place the seal directly over the wound, ensuring it extends at least two inches beyond the wound edges on all sides.
-
For a vented chest seal: Ensure the valve or vent is centered over the wound. Press down firmly around all edges, creating a complete seal. The valve will handle air release.
-
For a non-vented chest seal: Apply the same way, pressing the entire adhesive surface firmly onto the dry skin.
Step 6: Check for and Seal Additional Wounds
Thoroughly check for an exit wound, which may be on the patient's back or side. If found, you must apply a chest seal to that wound as well. An unsealed exit wound is just as dangerous as the entry.
Step 7: Monitor and Reassess
After application, monitor the patient closely. Watch for increased respiratory distress, which could indicate a developing tension pneumothorax, especially if using a non-vented chest seal. If such signs appear and you used a non-vented seal, you may need to lift one edge to release trapped air before resealing. Continuously monitor the seal's adhesion.
Improvised Chest Seal Options
In a true emergency without a commercial field medical kit chest seal, you may need to create an improvised chest seal. The principles remain the same: occlude the wound and, ideally, provide a one-way valve.
-
Use a sterile dressing, plastic wrap, a foil wrapper, or even a credit card as the occlusive material.
-
Tape it down on three sides only, leaving the bottom edge untapped. This creates a makeshift flutter valve that allows air to escape but seals on inhalation.
-
This is a last-resort measure. A commercial seal is far more reliable and effective.
Final Thoughts
Knowing how to use a chest seal in the field is a critical skill that can mean the difference between life and death in the critical minutes after a traumatic injury. It directly addresses the lethal mechanics of a sucking chest wound and is a frontline defense against tension pneumothorax. Understanding the difference between a vented chest seal and a non-vented chest seal, and practicing the swift, confident application of this life-saving tool, should be a cornerstone of any serious first responder or tactical medical training.
Your readiness depends on both your knowledge and the quality of your gear. For mission-critical medical equipment you can trust, including premium chest seals designed for real-world application, explore the purpose-built kits and components at Redemption Tactical. Don't wait for the emergency to discover your kit's shortcomings. Prepare with confidence today.
FAQs (Frequently Asked Questions)
Q: Can you use a regular bandage or gauze to cover a chest wound?
No. Standard gauze is porous and will not prevent air from being sucked into the pleural cavity. You must use an occlusive dressing for a chest wound specifically designed to create an airtight seal.
Q: How many chest seals should you carry in a kit?
At a minimum, carry two. It is common for a penetrating injury to have both an entry and an exit wound, requiring two seals. Having extras is always prudent.
Q: What if the wound is bleeding heavily and needs to be sealed?
Control major, life-threatening bleeding with direct pressure first. Once controlled, proceed with chest seal application. The seal itself may help with some external bleeding, but its primary job is to stop air entry.
Q: Where on the body should you place a chest seal if you have to self-apply?
The steps are the same: expose the wound, wipe it, and apply on exhalation if possible. It will be difficult, so practicing with a trainer seal during first-aid training is highly recommended.
Q: When should you NOT use a chest seal?
Do not use a chest seal on large wounds where the dressing cannot adequately cover the edges, or on wounds to the abdomen. It is specifically for penetrating chest trauma.
