How to Treat a Sucking Chest Wound

A sucking chest wound is a hole in the chest (from a gunshot wound, stabbing or other puncture wound) that makes a new pathway for air to travel into the chest cavity. When the chest cavity is expanded in order to inhale, air not only goes into the mouth and nose like normal, it also goes into the hole.

Sucking chest wounds are dangerous because they lead to collapsed lungs (pneumothorax). Treating a sucking chest wound requires two things: keeping air from going in while still letting extra air out.

It can be difficult to identify when a penetrating wound to the chest is sucking air or not. They don't always make noise.

1. Call 911. If the 911 operator gives instructions, follow those instructions and ignore the rest of this page. If 911 is not available, get the patient to emergency medical help as soon as possible.
2. Seal the sucking chest wound. Put something plastic (preferably sterile or at least clean) over the hole and tape it down. You can use a first aid device called a chest seal for this. Or, another trick is to use the packaging that sterile dressings come in. Peel open the packaging and tape the entire plastic portion over the sucking chest wound.
3. Watch for signs of a tension pneumothorax. A tension pneumothorax is a collapsed lung that has leaked lots of air between the chest wall and the lung, building up pressure and pushing the lungs over to the other side of the body. If the pressure builds too much, the victim will develop a dangerously low blood pressure (shock) and likely die. Signs of a tension pneumothorax include:
   1. Severe shortness of breath
   2. Unequal chest (one side looks bigger than the other)
   3. Veins on the neck bulging (jugular vein distension)
   4. Blue lips, neck or fingers (cyanosis)
   5. No lung sounds on one side

Taping the seal on three sides is supposed to allow air to escape while blocking air from sucking in. In my experience, that doesn't really work so well. Blood tends to glue the plastic to the wound. Careful observation works much better than improvised chest seals. Just watch for signs of pneumothorax and remove the seal if necessary. There are chest seals made specifically for sucking chest wounds, but nothing beats careful observation.

If you do have to remove a chest seal to relieve a tension pneumothorax, you probably should leave it off. Removing the seal will most likely let the pressure out and equalize the pressure inside the chest with the outside atmosphere. Again, watch the patient closely for signs of tension pneumothorax.

Recognizing a tension pneumothorax is difficult if you haven't been trained in first aid. If you have a patient with a penetration wound to the chest of any kind—industrial accident, gunshot wound, stabbing, etc.—the most important step is getting professional emergency medical help. Don't hesitate to call 911 or get the patient to the emergency department as quickly as possible.