A client has a sucking stab wound to the chest. Which action should the nurse take first?
A. Draw blood for a hematocrit and hemoglobin level.B. Apply a dressing over the wound and tape it on three sides.***
C. Prepare a chest tube insertion tray.
D. Prepare to start an I.V. line.
Overview
A sucking chest wound (SCW) happens when an injury causes a hole to open in your chest. SCWs are often caused by stabbing, gunshots, or other injuries that penetrate the chest.
Signs of an SCW include:
an opening in the chest, about the size of a coin
hissing or sucking sounds when the person inhales and exhales
heavy bleeding from the wound
bright red or pinkish, foaming blood around the wound
coughing up blood
SCWs sometimes make no noise. Treat any wound caused by chest penetration as an SCW.
What should I do to provide immediate first aid?
If an object is still protruding from the wound, don’t remove it. This can make the injury worse.
Call your local emergency services immediately. If no emergency services are available, get the injured person to a hospital as soon as possible. Follow any steps that the emergency services operator gives you. You may be directed to do the following:
Sterilize your hands with soap and water.
Put on gloves or other hand protection.
Remove any loose clothing or objects covering the wound. Don’t remove clothing that’s stuck to the wound.
Keep a hand over the wound while preparing a dressing. Protect your hand with a glove or other hand protection. If possible, have someone else put their hand over the wound. If no one else is available, have the injured person cover the wound with their hand if they’re still able to do so.
Find a chest seal or sterile, medical-grade plastic, or tape to seal the wound. If you don’t have medical plastic, use a clean Ziploc bag or a credit card for the wound. Use your hands if you have no other option.
If possible, ask the person to breathe out to release any excess air.
Place tape, plastic, or a chest seal over any hole that’s sucking in air, including entry and exit wounds. Make sure no air enters any wound.
Secure the tape or seal with occlusive dressingor similar wrapping material that can create a water and airtight seal. Make sure the seal has at least one open side to let out air without letting air in.
Remove the seal if you notice symptoms of tension pneumothorax, or a buildup of air in the chest. This happens when a lung leaks air into the chest and builds pressure. This can cause extremely low blood pressure (shock) and be fatal. Symptoms include crackling sounds when the person breathes in or out (subcutaneous emphysema), lip or finger blueness (cyanosis), enlarged neck veins (jugular vein distention), short, shallow breaths, and one side of the chest appearing larger than the other.
Keep the person on their side unless this makes it harder for them to breathe. Let out as much excess air as possible from the chest while making sure that the person can still breath.
If the person loses consciousness or stops breathing, do the following:
perform cardiopulmonary resuscitation (CPR)
use a blanket to keep them from getting too cold
don’t let the person eat or drink
put pressure on wounds to slow bleeding
How is this type of wound treated in a hospital?
Once the person has been admitted into the hospital, the following may be done:
A facemask is placed over the nose and mouth of the patient to deliver oxygen into their body.
The patient is connected to an intravenous (IV) catheter and given anesthesia so that a doctor or surgeon can operate.
During surgery, a small incision is made on the patient’s chest. The surgeon inserts a chest tube into the patient’s chest cavity (the pleural space) to drain fluids from the area around their lungs. The chest tube stays in until all excess air and fluid has been drained.
The surgeon then surgically closes the wound with stitches or sutures to prevent further bleeding and to keep air from getting into the pleural space.
Are there any possible complications?
Possible complications of an SCW that can be fatal include:
tension pneumothorax
loss of oxygen in the blood (hypoxia)
shock from blood or oxygen loss (hypotension)
fluid buildup in the chest cavity
injuries to vital organs, such as the heart, lungs, or gastrointestinal system
What is recovery like from an SCW?
If an SCW isn’t treated quickly in a medical facility, it can be fatal.
Typical recovery from an SCW takes about 7 to 10 days, or longer if there are multiple wounds. Further surgeries may be needed to treat any punctures in the lungs, muscles, heart, or other organs that may have occurred.
Depending on how extensive the wound is and what other treatments are necessary, full recovery can take three to six months.
Outlook
SCWs can be deadly or cause serious health problems if they’re not treated quickly. Doing quick first aid within the first few minutes, and getting the person to a hospital, can save their life and prevent long-term complications.
Which is a potential complication of a low pressure in the endotracheal tube cuff?
Critical importance of tracheal tube cuff pressure management
Taoyuan Robert Feng, Ying Ye, D John Doyle
Taoyuan Robert Feng, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, United States
Ying Ye, Cleveland Clinic, Cleveland, OH 44195, United States
D John Doyle, Department of General Anesthesia, Cleveland Clinic Abu Dhabi, PO Box 112412, Abu Dhabi, United Arab Emirates
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to:
Dr. D John Doyle, MD, PhD, Chief, Department of General Anesthesia, Cleveland Clinic Abu Dhabi, PO Box 112412, Abu Dhabi, United Arab Emirates. djdoyle@hotmail.com
Telephone: +971-52-6997627 Fax: +971-2-4108374
Received: January 25, 2015
Peer-review started: January 30, 2015
First decision: April 10, 2015
Revised: April 29, 2015
Accepted: May 27, 2015
Article in press: May 28, 2015
Published online: July 27, 2015
