Major Wound Care

Chest Injuries

Wounds to the chest can cause breathing problems and require immediate medical help. Chest injuries can include fractured ribs, a more serious flail chest, penetrating injuries, and air getting trapped outside the lungs in the chest cavity.

Pneumothorax

A penetrating chest injury can lead to a condition known as a pneumothorax, which occurs when air is trapped in the chest cavity, but outside of the lungs. A similar condition is a hemothorax, where instead of air, blood is trapped. The air can become trapped either due to an opening in the chest wall, or damage to the lungs.

A pneumothorax needs immediate attention, as the trapped air can build up and put pressure on the lungs. If too much pressure builds up, the lung will collapse. A collapsed lung severely impairs breathing and can be difficult to re-inflate later.

The best way to give first aid for a pneumothorax is by preventing the build-up of air through a penetrating chest wound.

First aid for a penetrating chest wound

To give first aid for a penetrating chest wound, perform the following steps:

  1. Perform a scene survey and call 9-1-1.
  2. Perform a primary survey.
  3. If the open chest wound has significant bleeding, cover it by pressing the casualty’s hand, a bystander’s hand, or your own hand over the wound (preferably a gloved hand). If there is no significant bleeding, the first aider may leave the wound exposed, or use a dressing that will allow air to pass (non-occlusive). If the dressing becomes saturated, it must be changed.
  4. Place the casualty in the position that makes breathing easiest. This position is usually semi-sitting, leaning slightly towards the injured side. This position keeps the uninjured side of the chest upward so it can be used most effectively for breathing.
  5. Do not seal the wound with an airtight dressing, but cover the wound to prevent further contamination.
    If the dressing becomes wet, replace it with a dry dressing.
  6. Give ongoing casualty care, monitoring breathing often.

Gunshot Wounds

A specific penetrating injury that requires immediate attention is a gunshot wound. First aid for a gunshot wound will depend on where on the body the injury is.

First aid for gunshot wounds to the body

Gunshot wounds to the body are dangerous in two ways. First is the direct damage to the organs the bullet encounters. Secondary to that is the pressure wave that accompanies a bullet wound. This wave will spread out from the bullet’s route as it is slowed by the body, causing additional injury to surrounding tissues and hollow organs.

  1. Ensure your own safety on the scene. Based on your risk assessment, you may need to wait to enter the scene until professional response is available.
  2. Call 9-1-1.
  3. Follow the steps above for a penetrating chest injury.

First aid for gunshot wounds to the extremities

A gunshot wound to the extremities can range from superficial to life-threatening. A bullet that grazes the skin or stays close to the surface will hurt and bleed a lot but is generally not life-threatening. Treat as you would for a bleeding wound.

If a bullet goes deeper into the extremity, in particular in the upper arm or upper leg, it can hit major arteries and/or fracture bones. In these cases, treat as you would for severe bleeding. Consider a tourniquet for gunshot wounds to the upper leg. A bullet that hits the major artery in the upper leg can cause a person to bleed to death very quickly.

Flail Chest

A flail chest occurs when several ribs in the same area are broken in more than one place. The flail segment moves opposite to the rest of the chest while breathing, which causes pain for the casualty.

Signs and symptoms of a flail chest include:

  • Paradoxical chest movement
  • Breathing is very painful, and the casualty may support the injured area
  • Bruising at the injury site

First aid for a flail chest

To give first aid for a flail chest, perform the following steps:

  1. Steady and support the head and neck.
  2. Perform a primary survey. If the casualty complains of difficulty breathing and pain in the chest, expose and examine the injury.
  3. Support the injured area with your hand, which may make breathing easier. Give first aid for ineffective breathing if needed.
  4. Secure the arm to the chest wall with a broad bandage to prevent movement of the arm.
  5. Give ongoing casualty care until medical help takes over.