Penetrating thoracic trauma injuries and the use of Chest Seals

An open chest wound, sometimes called a “sucking chest wound”, can either allow external air to enter the thorax, creating a pneumothorax, or become trapped in the thorax, potentially creating a life-threatening tension pneumothorax. These chest conditions are typically caused by a penetrating injury, such as from shrapnel, gunshot, stabbing or internally from a broken rib penetrating a lung. When air is unable to escape from the pleural space, resulting in increased intrapleural pressure, this pressure can increase to the point where it interferes with venous return, causing circulatory instability, which may result in traumatic cardiac arrest, or compression of lungs, causing ventilatory failure.

This condition is referred to as tension pneumothorax, which can kill the patient within minutes, if left untreated. Tension pneumothorax is the second largest cause of preventable battlefield death^[1][2][3].

Annually, more than 50,000 deaths due to trauma-related pneumothoraces occur in the USA. Pneumothorax ranks second only to rib fracture as the most common sign of chest injury and can be seen in 40–50% of chest trauma patients^[4][5].

First responders can play a significant role in pre-hospital care of penetrating trauma. A study showed that in 19% of deaths from penetrating chest trauma, the only injury at autopsy was tension pneumothorax and/or hemothorax^[6].

The updated TCCC Guideline^[7] (June 2013) for the battlefield management of open pneumothorax is;

“All open and/or sucking chest wounds should be treated by immediately applying a vented chest seal to cover the defect. If a vented chest seal is not available, use a non-vented chest seal.”

The vented chest seal has a one-way valve, which allows air to escape, but not enter, the chest cavity, which is why it is recommended that open chest wounds are covered with a vented chest seal whenever possible^[8]. If you must use an occlusive chest seal (not recommended or preferred), then you must be vigilant in continued patient assessment, as air may continue to build up inside the chest.

Safeguard Medical offers a variety of solutions for the Respiratory stage in the MARCH mnemonic. The Russell Chest Seal™ is used to cover such penetrating chest wounds, and its four apertures and one-way valve mechanism allows air to escape from the pleural cavity without being drawn back in. This aims to minimise lung collapse associated with this injury and to facilitate lung re-inflation.

Learn more about our variety of solutions in the Respiration category.

[1] Holcomb et al. Eliminating Preventable Death on the Battlefield. ARCH SURG/VOL 146 (NO. 12), DEC 2011

[2] Bellamy et al. Prevalence of Tension Pneumothorax in Fatally Wounded Combat Casualties. Trauma, Vol 60, Pt 3, Pg 576. 2006

[3] Kiley KC: Management of soldiers with tension pneumo- thorax. Army Surgeon General memo 25 August 2006.

[4] Respirology (2004)9, 157–164

[5] Lee C, Revell M, Porter K, et al. The prehospital management of chest injuries: a consensus statement. R Coll Surg Edinb Emerg Med J. 2007; 24:220–224.

[6] JTrauma 1994; 37:9-12

[7] Bulter, F. et al. Management of Open Pneumothorax in Tactical Combat Casualty Care: TCCC Guidelines Change 13-02

[8] Kheirabadi BS, et al. Vented versus unvented chest seals for treatment of pneumothorax and prevention of tension pneumothorax in a swine model. J Trauma Acute Care Surg. 2013 Jul;75(1):150-6.