Kpekpeɖeŋunana gbãtɔ si woxɔ le akɔta si wono kple aɖuɖɔtoe si mu¶

Normal human breathing relies on an airtight, negative-pressure vacuum inside the thoracic cavity. Between the outer surface of the lungs (visceral pleura) and the inner wall of the ribcage (parietal pleura) lies the microscopic pleural space, maintained at a sub-atmospheric negative pressure of roughly -4 to -8 centimeters of water. When a gunshot, knife blade, shrapnel fragment, broken rib, or spontaneous lung bleb tears into this sealed vacuum, air rushes into the pleural space and strips the elastic lung away from the chest wall, causing a collapsed lung (pneumothorax).

When an external hole through the chest wall is wide enough (roughly two-thirds the diameter of the windpipe or larger), air takes the path of least resistance and sucks directly through the chest wall instead of coming down the trachea, creating a sucking chest wound (open pneumothorax). Worse still, if air enters the chest cavity with each breath or gets trapped under a completely sealed bandage with no way to escape, pressure inside the chest builds above atmospheric levels, crushing the lung completely and kinking the great veins returning blood to the heart. This lethal emergency, called a tension pneumothorax, causes fatal obstructive cardiac arrest within minutes unless recognized and decompressed.

Wɔ esia fifia¶

1. Call your local emergency number immediately and request Advanced Life Support (ALS) paramedics. Dial 911 in the United States and Canada, 112 across the European Union, 999 in the United Kingdom, 000 in Australia, or check the directory of xexlẽdzesi siwo wozãna kpata. Clearly report a penetrating chest wound or suspected collapsed lung so paramedics bring chest seals, needle decompression kits, and oxygen.
2. Expose the entire chest AND gently check the back and armpits for an exit wound. Cut or lift the shirt completely up to the neck. Whenever you find a chest wound on the front, immediately roll or feel underneath the shoulders, armpits (axillae), and back for a second hole, and seal the larger or more heavily bubbling hole first.
3. Cover an open sucking chest wound immediately with a gloved hand during exhalation, then apply a commercial Vented Chest Seal or a Three-Sided Occlusive Dressing. Wipe blood and sweat off the skin so the adhesive sticks, ask the patient to breathe out (exhale), and smooth a commercial vented chest seal over the hole. If you do not have a commercial vented seal, tape a square of airtight plastic wrap, foil, or a defibrillator pad wrapper on THREE sides only, leaving the bottom corner untaped as a flutter valve.
4. Never wrap a tight elastic bandage all the way around the chest and never leave an unvented four-sided airtight seal unattended. Sealing an open chest wound completely airtight on all four sides without a vent valve traps air leaking from the injured lung inside the chest, rapidly turning a survivable open wound into a fatal tension pneumothorax.
5. Sit a conscious, breathing patient upright or semi-reclined (or tilted slightly onto the injured side) to let the good lung expand. Never force a conscious patient struggling to breathe with a chest injury to lie flat on their back unless spinal immobilization requires it.
6. Monitor breathing every 60 seconds and "BURP" the chest seal immediately if the patient becomes more short of breath, cyanotic, or loses their radial pulse. If the patient's breathing suddenly worsens after a chest seal is applied, peel back one corner of the dressing for 3 to 5 seconds during exhalation to let trapped pressurized air hiss out of the chest, wipe away any blood clot clogging the valve, and re-smooth the vented seal.

Emergency decision tree for open chest wounds and collapsed lung¶

flowchart TD
    Start["Penetrating Chest Trauma, Blunt Rib Impact, or Sudden Sharp Pleuritic Chest Pain"]
    CallEMS["Call Emergency Medical Services (ALS Paramedics) Immediately<br/>Expose entire anterior chest, armpits, and posterior back"]
    ImpaleCheck{"Is a Knife, Rod, or Shard Still Impaled in the Chest?"}
    ImpaleChest["IMPALED CHEST OBJECT PROTOCOL<br/>1. DO NOT pull out the impaled object<br/>2. Seal sucking gap around base of blade with petroleum gauze/plastic<br/>3. Leave one corner unsealed to vent air<br/>4. Stabilize blade with twin bulky gauze rolls"]
    OpenCheck{"Is There an Open Wound in the Chest Wall?<br/>(Hissing/sucking sound, frothy pink blood bubbles, chest wall defect)"}
    ClosedPneumo["CLOSED PNEUMOTHORAX / HEMOTHORAX / FLAIL CHEST<br/>1. Do NOT apply chest seal if skin is intact<br/>2. Sit patient upright or semi-reclined (Fowler's position)<br/>3. Calm patient to slow rapid breathing<br/>4. Watch continuously for Tension Pneumothorax signs"]
    SealChoice{"Do You Have a Commercial Vented Chest Seal?<br/>(HyFin Vent, SAM Chest Seal, Asherman, Russell, Halo Vent)"}
    CommercialSeal["Apply Commercial Vented Chest Seal<br/>1. Wipe blood and sweat dry around wound<br/>2. Center one-way valve/channels directly over hole at end-exhalation<br/>3. Seal second hole on back if exit wound exists"]
    ThreeSided["Build Improvised Three-Sided Flutter-Valve Dressing<br/>1. Cut airtight plastic square 5 cm (2 in) wider than wound<br/>2. Tape TOP, LEFT, and RIGHT edges airtight to dry skin<br/>3. Leave BOTTOM corner completely UNTAPED to drain blood & vent air"]
    MonitorTension{"Monitor Every 60 Seconds: Worsening Dyspnea, Agitation,<br/>Absent Breath Sounds, Hypotension, or Neck Vein Distension?"}
    BurpSeal["TENSION PNEUMOTHORAX DEVELOPING: BURP THE SEAL NOW<br/>1. Peel back one side of chest seal for 3 to 5 seconds<br/>2. Listen/feel for rush of trapped air and blood escaping<br/>3. Wipe clotted blood off wound and re-apply vented seal<br/>4. ALS Paramedic performs Needle Decompression / Finger Thoracostomy"]
    StableTransport["Continue Monitoring & Reassuring Patient<br/>Position upright or tilted toward injured side until ALS arrival"]

    Start --> CallEMS
    CallEMS --> ImpaleCheck
    ImpaleCheck -->|Yes: Object Impaled| ImpaleChest
    ImpaleCheck -->|No: No Object Present| OpenCheck
    OpenCheck -->|No: Closed Skin| ClosedPneumo
    OpenCheck -->|Yes: Open Chest Wound| SealChoice
    SealChoice -->|Yes| CommercialSeal
    SealChoice -->|No| ThreeSided
    ImpaleChest --> MonitorTension
    CommercialSeal --> MonitorTension
    ThreeSided --> MonitorTension
    ClosedPneumo --> MonitorTension
    MonitorTension -->|Yes: Tension Signs Present| BurpSeal
    MonitorTension -->|No: Breathing Stable| StableTransport
    BurpSeal --> MonitorTension

Comparing life-threatening thoracic emergencies¶

Thoracic trauma and spontaneous pleural air leaks produce five distinct clinical syndromes. Distinguishing a simple collapsed lung from an open sucking chest wound, a tension pneumothorax, a massive hemothorax, or a flail chest determines both immediate positioning and life-saving decompression.

Dɔléle ƒe dɔwɔwɔ le akɔta ƒe abi si le no nom (Open Pneumothorax) .¶

Le ŋutilã ƒe nɔnɔme siwo sɔ me la, ne wò akɔtaƒu ƒo ɖe anyi eye wò akɔta ƒe lãmekawo he wò akɔta yi gota la, akɔta ƒe nyaƒoɖeamenu ɖiɖina vie wu yame ƒe nyaƒoɖeamenu si le egodo (tso -4 va ɖo -8 \(\text{cmH}_2\text{O}\)). Esi wònye be wotu akɔta ƒe gli la keŋkeŋ ta la, mɔ ɖeka kolia si dzi ya ato age ɖe akɔta lae nye to nu me, yaƒoƒo, kple aɖuɖɔtoe me, si naa lãkusi eveawo siaa dea ya me agbagbadzedze aɖeke manɔmee.

"Eve-Etɔ̃ Tracheal Diameter" ƒe dzidzenu¶

An adult human trachea has an internal diameter of roughly 18 to 24 millimeters (0.7 to 0.95 inches). If a knife blade, high-velocity rifle round, shotgun blast, or impaled fence spike creates an open hole through the chest wall whose cross-sectional diameter is two-thirds the diameter of the trachea (roughly 12 to 15 millimeters / 0.5 to 0.6 inches) or larger, the laws of fluid dynamics dictate that air follows the path of least resistance:

1. Because the short hole through the ribcage offers far less airway resistance than the long, branching bronchial tree, every time the victim tries to inhale, outside room air rushes directly through the hole in the chest wall into the pleural space rather than coming down the windpipe into the lungs.
2. Esi xɔa me ya yɔ ʋuka si le akpa si xɔ abi la me la, lãkusi si le akpa ma la mu keŋkeŋ eye mete ŋu trɔa ɔksidzin o.
3. Nusi gavloe wue nye be ne amesi ŋu wowɔ nuvevii le gbɔgbɔm hele gbɔgbɔm la, ya si me carbon-dioxide sɔ gbɔ ɖo xoxo la ƒua du yia ŋgɔ kple megbe viɖe aɖeke manɔmee le lãkusi si mu kple lãkusi si le lãmesẽ me (Pendelluft alo "pendulum ya") dome, evɔ mediastinum (si me dzi kple vena cava le) ya nɔa ʋuʋum tso axa ɖeka yi axadzi (mediastinal flutter), si nana ɖeɖi tea dɔnɔa ŋu kabakaba eye wòhea hypoxia sesẽ kple... hypercapnia ƒe dɔléle si woyɔna be hypercapnia.

Classic signs of an open sucking chest wound¶

• Audible sucking, hissing, or slurping sound coming from the chest or back wound each time the casualty gasps for air.
• Frothy, bright pink or red blood bubbling or sputtering out of the wound during exhalation or coughing (unlike dark red venous oozing or bright red arterial spurting from an arm wound, frothy bubbles prove air from the respiratory tract or pleural space is mixing with blood).
• Subcutaneous emphysema: Air forced under the skin of the chest wall and neck creates a strange, crackling "Bubble Wrap" or "Rice Krispies" sensation (crepitus) when you press your fingers lightly on the skin around the collarbone or ribs.

Step-by-step technique: Applying a Vented Chest Seal or Three-Sided Dressing¶

The immediate goal of first aid for an open chest wound is to convert an open pneumothorax into a simple vented pneumothorax: blocking outside air from sucking in during inhalation while allowing trapped internal air and blood to escape during exhalation.

Method A: Commercial Vented Chest Seal (Gold Standard: CoTCCC & First Aid Guidelines)¶

Modern trauma kits carry purpose-built Vented Chest Seals (such as the HyFin Vent, SAM Chest Seal, Russell Chest Seal, Halo Vent, or Bolin/Asherman seal). These feature an aggressive medical hydrogel adhesive pad equipped with either a raised one-way dome valve or multiple laminar-flow vent channels that let air and blood escape outward while sealing flat against the skin when the patient inhales.

1. Expose the wound and check the back: Cut the shirt away completely. Always check the back and armpits for an exit wound; if there are two holes (an entry and an exit), apply a vented chest seal to the primary sucking hole and a second seal (vented if available) to the exit hole.
2. Wipe the skin around the wound completely dry: This is the step most rescuers forget under stress. Even the best hydrogel adhesive will slide right off skin coated in wet blood, sweat, mud, or rainwater. Use a dry gauze pad inside the chest seal package to briskly wipe a 10-centimeter (4-inch) circle of skin around the hole as dry as possible.
3. Peel the backing and apply at the end of exhalation: If the patient is conscious, ask them to breathe out (exhale) and pause for one second (exhaling pushes extra air out of the pleural space before you seal it). Center the one-way valve or laminar vent channels directly over the hole and press the adhesive firmly from the center outward to eliminate wrinkles.

Method B: Improvised Three-Sided Occlusive Flutter-Valve Dressing¶

If you do not have a commercial vented chest seal in your first aid kit, you must construct a Three-Sided Occlusive Dressing:

1. Find a piece of completely airtight, non-porous flexible material: Plain gauze pads do not work by themselves because air passes right through woven cotton. Use one of the following airtight barriers:
2. The clean inner foil or plastic wrapper of a sterile gauze dressing or AED defibrillator pad.
3. A square cut from a heavy-duty plastic freezer bag, nitrile glove package, or clean plastic cling wrap.
4. Sterile petrolatum (Vaseline) gauze covered with a layer of foil or plastic.
5. In the first 10 seconds before materials are ready: Slap your gloved palm directly over the sucking hole during exhalation, lifting the heel of your hand slightly when the patient exhales to let air out, and sealing it flat when they inhale.
6. Cut the plastic square at least 5 centimeters (2 inches) wider than the wound on all sides: If the plastic is too small, the suction of inhalation will pull the entire piece of plastic into the wound hole.
7. Wipe the surrounding skin dry and place the plastic over the wound as the patient exhales.
8. Tape THREE sides completely airtight, leaving the BOTTOM corner or fourth side completely UNTAPED:
9. Apply wide medical tape or duct tape completely overlapping the top edge, left edge, and right edge of the plastic square so no air can leak under those three edges.
10. Leave the bottom edge (or the lowest gravity-dependent corner) completely free of tape.
11. How the flutter valve works: When the patient inhales, negative pressure inside the chest pulls the loose plastic sheet flat and wet against the skin, sealing the hole airtight so outside air cannot enter. When the patient exhales or coughs, positive pressure inside the chest pushes trapped air and blood out from underneath the untaped bottom edge like a one-way flapper valve.

Recognizing and treating Tension Pneumothorax ("Burping the Seal")¶

A tension pneumothorax is an immediately fatal mechanical catastrophe that can develop either from a closed rib fracture / lung laceration or when an open chest wound dressing becomes clogged or sealed on all four sides.

How tension pneumothorax kills (Obstructive Shock)¶

Le gbɔgbɔ ɖesiaɖe me la, ya mililita 50 va ɖo 100 dona tso lãkusi si vuvu la me yia lãkusi si xaxa la me eye mate ŋu asi atrɔ ayi aɖuɖɔtoeawo me alo ado go to akɔta ƒe gli me o: 1. Nyaƒoɖeamenu si le akɔta ƒe akpa si xɔ abi la me dzina ɖe edzi tso negative (-5 \(\text{cmH}_2\text{O}\)) va ɖoa nyuitɔ sesẽ (+15 va ɖo +30 \(\text{cmH}_2\text{O}\)). 2. Wogbãa lãkusi si xɔ abi la wòzua bɔl sue aɖe si me ya mele o le hilum la gbɔ, esime wotua lãkusi si le akpa ma la ɖe anyime yia ƒodoa me. 3. Ya si me ya sesẽ le ƒe kotoku si le kekem ɖe enu la ƒoa mediastinum bliboa (dzi, aorta, superior vena cava, inferior vena cava, kple trachea) ɖe axadzi yia akɔta ƒe akpa si mexɔ abi o, si ƒoa lãkusi nyui susɔea nu ƒu. 4. Afɔɖeɖe si wua ame: Esi wònye be vena cava si le etame kple esi le anyime si ƒe gli le sue la trɔa ʋu si me oxygen mele o yia dzia ƒe ɖusime le ʋuka ƒe nyaƒoɖeamenu si bɔbɔ ŋutɔ me (2 va ɖo 8 mmHg ko) ta la, mediastinal shift kinks veins gã eveawo siaa abe abɔ me hose si wobɔbɔ ene. Ʋu megate ŋu gena ɖe dzia me o (preload ɖiɖi va ɖoa zero), dzi ƒe dɔwɔwɔ dzi ɖena kpɔtɔna ŋutɔ, eye dɔnɔa kpea fu Pulseless Electrical Activity (PEA) dzitodzito tso mɔ̃ dzadzɛ obstructive shock me.

Tension Pneumothorax ƒe aflaga dzĩ 7 siwo wokpɔna le atikewɔƒewo¶

Lé ŋku ɖe dɔnɔ ɖesiaɖe si ŋu akɔta le abe akpɔkplɔ ene ŋu be nàkpɔ dzesi siwo gbɔna be akɔta ƒe nyaƒoɖeamenu le dzidzim ɖe edzi:

Step-by-step: How to "BURP" a Chest Seal immediately¶

If a casualty wearing a commercial chest seal or three-sided plastic dressing shows any of the warning signs above (worsening air hunger, agitation, bluish lips, or weakening pulse):

1. Grasp one corner of the chest seal or plastic dressing with gloved fingers and peel it back off the skin to expose the wound hole completely.
2. Press gently on the skin beside the wound or wait as the patient exhales for 3 to 5 seconds: When a true tension pneumothorax is present, you will immediately hear or feel a loud rush or hiss of trapped air and foamy blood blasting out of the wound, followed within seconds by the patient taking a deep breath and their color and pulse improving.
3. Wipe away the clotted blood plug: Use a sterile gauze pad to wipe away any thick jelly-like blood clots that were plugging the wound track or the chest seal's one-way valve.
4. Re-smooth the vented chest seal (or apply a fresh clean one) at the end of exhalation: If the chest seal's valve is hopelessly clogged with blood and you have no spare vented seal, leave the corner untaped or leave the wound covered only with a loose, air-permeable sterile gauze pad while monitoring bleeding.

How ALS Paramedics and Physicians treat Closed Tension Pneumothorax¶

If a patient develops a tension pneumothorax with no external hole in the chest wall (for example, after a blunt steering-wheel impact, motorcycle crash, or spontaneous bleb rupture), there is no chest seal to burp. Advanced Life Support (ALS) paramedics and trauma clinicians perform immediate Needle Thoracostomy Decompression: * Inserting a long, large-bore (10-to-14-gauge, 8.25-centimeter / 3.25-inch) over-the-needle catheter directly over the top edge of the lower rib (to avoid the intercostal artery, vein, and nerve running in the groove along the bottom edge of each rib) at either the 5^th intercostal space in the anterior/mid-axillary line (the modern ATLS 10^th Edition preferred site in adults) or the 2^nd intercostal space in the mid-clavicular line, instantly venting the pressurized air with an audible hiss until a definitive chest tube (tube thoracostomy) is placed.

Optimal patient positioning and managing Flail Chest¶

How to position a patient with a chest injury¶

• Conscious and breathing: Allow the patient to sit upright or semi-reclined at a 45-to-60-degree angle (Fowler's position), or leaning slightly forward on their knees (tripod position). Sitting upright uses gravity to pull the abdominal organs downward off the diaphragm and keeps pooling pleural blood (hemothorax) at the bottom of the chest cavity so the upper lung lobes can still breathe.
• Tilting toward the injured side (when preferred): If a patient has a sealed chest wound or broken ribs on one side and prefers to lean, tilting them slightly toward the injured side splints the painful ribs against the stretcher or pillow and allows the uninjured upper lung complete freedom to expand fully without blood or secretions draining across the carina into the good lung.
• Unconscious and breathing (without spinal injury): Place the patient in the lateral recovery position with the INJURED side DOWN (healthy lung on top). Placing the injured side against the ground keeps internal bleeding inside the damaged lung from spilling across the mainstem bronchus and drowning the healthy lung, while letting the healthy top lung expand freely.

First aid for Flail Chest (Multiple Broken Ribs with Paradoxical Motion)¶

When a high-energy impact breaks two or more adjacent ribs in two or more places, that rectangular section of the ribcage loses its bony connection to the rest of the chest wall. * What it looks like (Paradoxical Breathing): When the person breathes IN, negative pressure inside the chest sucks the broken floating rib segment INWARD while the rest of the chest moves outward; when they breathe OUT, the broken segment puffs OUTWARD. * Why we NO LONGER tape the ribs or place heavy sandbags on a flail chest: Decades ago, rescuers wrapped elastic bandages tightly around the entire ribcage or laid a heavy sandbag on a flail segment. Clinical trials proved that strapping the chest wall or weighting it with sandbags restricts the healthy lung, worsens atelectasis (alveolar collapse), and rapidly precipitates respiratory failure. * Modern evidence-based care for Flail Chest: 1. Never wrap circumferential tape or elastic bandages around the chest. 2. Use gentle "Self-Splinting" with a soft pillow: Sit a conscious patient semi-upright and hand them a soft bed pillow, folded blanket, or plush jacket to hold gently against the injured ribs with their own arm, especially when coughing or riding over bumps. 3. Dzra ɖo be yeakpe ɖe gbɔgbɔ ŋu: Esi wònye be agbe ƒe afɔku vavãtɔ le flail chest mee nye aklã ƒe ʋuʋu goglo (aɖuɖɔtoe ƒe lãkusi si xɔ abi, si me tsi yɔ fũ) le akɔta gbagbãawo te tẽ ta la, ɖeɖi tea dɔnɔwo ŋu enuenu eye wòhiãna be woaxɔ ya nyui le kotoku-valve-mask (BVM) kple kɔdzi ƒe yaƒoƒo.

Kpekpeɖeŋunana gbãtɔ na abi si le no nom nye kpɔɖeŋu siwo me kɔ wu dometɔ ɖeka si me afɔɖeɖe bɔbɔe aɖe le miniti eve gbãtɔwo me xea mɔ na dzi ƒe dɔmawɔmawɔ tẽ. Bu kpekpeɖeŋunana gbãtɔ si ŋu woɖo kpee, Dzudzɔ Ʋuʋu, alo aɖaŋudzedze ƒe beléle na amesiwo ŋu afɔku le kpata to miaƒe dukɔa ƒe Atitsoga Dzĩ alo Ɣleti Dzĩ habɔbɔ, Amerika Amekolawo ƒe Kɔledzi, alo St John Ambulance dzi be yeasrɔ̃ akɔta ƒe nutrenu zazã kple nufiala.

Nya siwo wobiaa amewo enuenu¶

Wolé ŋku ɖe dzɔtsoƒewo ŋu¶

• Kɔmiti si Kpɔa Aʋawɔwɔ ƒe Aʋawɔwɔ ƒe Nuveviwɔamewo Dzi (CoTCCC / Joint Trauma System, United States): TCCC ƒe Mɔfiamewo na Atikewɔlawo: Open Pneumothorax (Vented Chest Seals), Burping, kple Tension Pneumothorax Decompression Dzikpɔkpɔ.
• Amerika Amekolawo ƒe Kɔledzi (ACS, United States): Advanced Trauma Life Support (ATLS) Sukuviwo ƒe Nusɔsrɔ̃gbalẽ (Tata 10 lia): Akɔta ƒe Nuveviwɔame, Open Pneumothorax, Flail Chest, kple Massive Hemothorax.
• Dukɔwo Dome Kadodo Kɔmiti si Kpɔa Gbɔgbɔyɔyɔ Gbɔ (ILCOR, Dukɔwo Dome) & Amerika Dzi Habɔbɔ / Amerikatɔwo ƒe Atitsoga Dzĩ Habɔbɔ: Nu ɖekawɔwɔ le Dzɔdzɔmeŋutinunya ŋu kple Atikewɔwɔ ƒe Kafukafunyawo (CoSTR) na Kpekpeɖeŋu Gbãtɔ Dzikpɔkpɔ le Akɔta ƒe Abi siwo le ʋuʋu ɖi ŋu.
• Dukɔa ƒe Lãmesẽnyawo Kple Belélename Ŋuti Nusrɔ̃ƒe (NICE) & NHS (United Kingdom): Afɔku Gãwo: Akɔta ƒe Nuveviwɔame ƒe Dzodzro Kple Edzikpɔkpɔ Gbãtɔ le Nɔnɔme Siwo Do Ŋgɔ Na Kɔdzi kple Kɔdzi (NG39).
• British Thoracic Society (BTS, United Kingdom): Pleural Disease Mɔfiame: Pneumothorax si dzɔna le eɖokui si kple esi gblẽa nu le ame ŋu la dzi kpɔkpɔ.
• Europa ƒe Gbɔgbɔyɔyɔ ƒe Aɖaŋuɖoha (ERC, Europa): Kpekpeɖeŋunana Gbãtɔ ƒe Mɔfiamewo kple Dzi ƒe Dɔléle si Me Nuveviwɔame Le (Nu Siwo Woate Ŋu Atrɔ: Tension Pneumothorax).

Mɔfiame siwo do ƒome kplii¶

• Impalement kple embedded duta nu li ke
• Ʋudodo dzi ɖuɖu sesẽ kple tourniquets
• Ƒodo ƒe ʋuʋudedi kple ƒodo ƒe abi si le ʋuʋu ɖi dzi kpɔkpɔ
• CPR kple dzidɔ ƒe gbugbɔgadzɔ
• Dzidziƒoame ƒe dzesidede kple beléle kpata
• Xexlẽdzesi siwo woxɔna le nudzɔdzɔ kpatawo me kple dukɔwo dome dɔdɔ