How should you manage an open pneumothorax?

Managing an open pneumothorax, commonly referred to as a "sucking chest wound," involves creating a barrier to prevent air from entering the pleural space during inhalation while allowing air to escape during exhalation. The appropriate treatment is to apply an occlusive dressing and secure it on three sides.

By taping the dressing on three sides, you create a one-way valve effect. This allows air that is trapped in the pleural space to escape when the patient exhales but prevents further air from entering the chest cavity during inhalation. This management helps stabilize the patient's condition and reduces the risk of a tension pneumothorax, which can occur if air continues to enter the pleural space and the pressure increases.

Inserting a chest tube immediately is typically reserved for subsequent definitive treatment and is not the first step in managing an open pneumothorax. While using a bag-valve mask may be necessary for assisting ventilation, it is not directly related to the management of an open pneumothorax and may worsen the situation by forcing more air into the chest cavity. Administering high-flow oxygen can support the patient’s oxygenation status, but it does not address the immediate need to manage the open chest wound. Therefore,