First Aid Brushup: Chest injuries

In my previous First Aid brushup post (covering blast injuries), I touched on responses to chest wounds.  There is more that can be said on that subject.  As stated in the last post, much of the information is drawn from Kym Eden's Fun with First Aid.  In addition, I have also drawn on John Haines, Emergency First Aid (2nd ed., Australian First Aid, Melbourne, n.d.).

Identification of Injury

An open chest wound represents a significant threat to the casualty's heart and lungs: these wounds exert significant and destabilising pressures inside the chest.

A chest wound can particularly be identified by -

1. The casualty's altered breathing.  Their breath may become irregular, rapid and shallow, and possibly very painful.  When the patient inhales there may be a sucking sound, and they may cough up frothy red blood.
2. The wound itself may bubble with a frothy liquid, or give off a bubbling or crackling sound.
3. The casualty's neck veins may become distended and enlarged, and the lips or fingernails may take on a blue tinge.

Treatment

A first aider should if at all possible wear gloves to reduce the risk of infection.  After the primary wound has been dealt with, check for exit wounds and manage them appropriately.

Conscious Casualty

A conscious casualty should be put into whatever position will is most comfortable.  Ideally, this will be seated and reclining, with their chest tipped towards the injured side.

Ideally, your first aid bag will contain plastic film (Glad-wrap or something similar; aluminium foil is also an acceptable choice).  Use the film to cover the wound and tape it at the top and on the left and right sides.  Do not tape the bottom edge: leaving this edge loose means the dressing will act as a one-way valve, letting air escape from the chest but not allowing it to enter.  If no film or foil can be obtained, use a hand to cover the wound.  If no other option is available, tape or bandage a sterile (or at least clean) dressing over the wound.

An ambulance should be sent for urgently.  In the meantime the patient should be kept warm, rested and comfortable and their breathing monitored.

Unconscious Casualty

An unconscious casualty should first be treated as for a failure of heart and lung function and the usual processes for CPR followed, including defibrillation if required.  Move the casualty into the recovery position with their injured side down and apply a dressing as for a conscious person.  Call for an ambulance, and while waiting for help to arrive, keep the casualty warm and monitor their breathing.