First Aid Treatment for 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.

Paramedic Team On Work
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Diagnosis

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

Assume any penetrating wound to the chest is a sucking chest wound, whether you hear it hissing or not.

Treatment Steps

If you're with someone who may have a sucking chest wound, swift action is critical.

Call 911

Call 911 immediately. If the operator gives you instructions, follow them and ignore the rest of this page.

If 911 isn't available, get the person to emergency medical help as soon as possible. If you're waiting for help to arrive, you may be able to take care of them at the scene.

Seal the Sucking Chest Wound

Put something plastic (preferably sterile or at least clean) over the hole and tape it down on three sides.

You can use a first aid device called a chest seal or improvise with the packaging sterile dressings come in. Peel open the packaging and tape the entire plastic portion over the wound.

Watch for Collapsed Lung

Be alert for signs of a collapsed lung also called a tension pneumothorax.

In a tension pneumothorax, the collapsed lung leaks lots of air between the chest wall and the lung, building up pressure. 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:

  • Severe shortness of breath
  • Unequal chest (one side looks bigger than the other)
  • Veins on the neck bulging (jugular vein distension)
  • Blue lips, neck or fingers (cyanosis)
  • No lung sounds on one side

If you suspect a tension pneumothorax is building, take off the seal to allow the air to escape.

Important Points

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 one 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 person to the emergency department as quickly as possible.

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Article Sources
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  1. Smith D. Chest injuries, what the sports physical therapist should know. Int J Sports Phys Ther. 2011;6(4):357-60.

  2. Richter T, Ragaller M. Ventilation in chest trauma. J Emerg Trauma Shock. 2011;4(2):251-9. doi:10.4103/0974-2700.82215

  3. Yoon JS, Choi SY, Suh JH, et al. Tension pneumothorax, is it a really life-threatening condition?. J Cardiothorac Surg. 2013;8:197. doi:10.1186/1749-8090-8-197

Additional Reading
  • Henry, Mark C., and Edward R. Stapleton. EMT Prehospital Care. 3rd Ed. 2004. Mosby/Jems.