b. Casualty coughing up blood (hemoptysis).
c. Frothy blood coming from the chest wound. (The air going in and out of an
open chest wound causes bubbles in the blood coming from the wound.)
d. Shortness of breath or difficulty in breathing.
e. Chest not rising normally when the casualty inhales. (The casualty may have
several fractured ribs, resulting in a flail chest.)
f. Pain in the shoulder or chest area that increases with breathing.
g. Bluish tint of lips, inside of mouth, fingertips, or nail beds (cyanosis). (This
color change is caused by the decreased amount of oxygen in the blood.)
h. Signs of shock such as a rapid and weak heartbeat.
CHECKING FOR OPEN CHEST WOUNDS
Check for both entry and exit wounds. Look for a pool of blood under the
casualty's back. Use your hands to feel for wounds.
a. If there is more than one open chest wound, treat the more serious (largest,
b. If the casualty has an open chest wound on his front and another open chest
wound on his back and they both affect the same lung, apply the flutter valve (three
taped sides) to the wound on the front. Apply a full seal (all four sides taped) to the
wound on the casualty's back.
EXPOSING THE WOUND
Expose the area around the open chest wound by removing, cutting, or tearing
the clothing covering the wound. If clothing is stuck to the wound, do not try to remove
the stuck clothing as this may cause additional pain and injury. Cut or tear around the
stuck clothing. Do not try to clean the wound or remove objects from the wound.
SEALING AN OPEN CHEST WOUND
Since air can pass through most dressings and bandages, you must seal the
open chest wound with plastic, cellophane, or other nonporous, airtight material to
prevent air from entering the chest and collapsing the lung. The wrapper from a field
first aid dressing or an emergency trauma dressing can be used. The following steps
assume that a field first aid dressing is being used.