Chest Seal (2 pcs)

Using a chest seal is fairly straightforward. Instead of trying to stop the blood from escaping, you're trying to stop the air from entering.

It's very important to treat a chest wound quickly. However, there are two maneuvers to perform first: controlling massive bleeding (applying a tourniquet) and opening the airway. Once you've done these two things, it's time to treat the chest wound.

Here are the steps to applying a chest seal:

1. Safety: As always, try to ensure you have gloves and eye protection (if possible). Also, move the patient away from any life-threatening situations (like a car fire).
2. Treat life threats: As we already stated, make sure you treat life threats. Of course, a chest wound is a life threat; however, you want to control major bleeding and airway obstruction first.
3. Assess: If you notice one wound to the chest, there may be more (for example, multiple stab wounds). With a gunshot wound (GSW), you may have an entry and exit wound. Be sure to assess the front and back of the patient, performing a rapid trauma exam.
4. Cover the sucking wound: With your hand, cover the sucking chest wound while you prepare your chest seal. Covering the wound with your hand will act as a temporizing measure as you prepare the seal, similar to applying direct pressure before applying a tourniquet.
5. Expose the wound: Tear the clothing away from the wound (trauma shears help). Trying to apply a chest seal over clothing isn't going to work. You need contact with the skin.
6. Clean the area: Quickly clean the area. Chest seals are pretty sticky; however, a lot of blood and moisture can disrupt their ability to adhere. Use a gauze pad or a towel to clean the wound.
7. Apply the seal: Place the wound in the center of the seal. Use your hands to push the edges of the seal down, like a sticker. If you have a vented chest seal, use it for the front of the patient. If you have a non-vented chest seal, place it on the back. (More about that later.)
8. Monitor breathing: A chest seal doesn't fix the problem; it only slows it down. The patient could still develop a tension pneumothorax. If the patient begins having serious trouble breathing, you may need to "burp" the seal. You pull the seal off momentarily, allowing air to escape (this should happen automatically with vented seals, but it doesn't always), then replace the seal.
9. Needle decompression: This is beyond the scope of this article; however, professionally trained individuals operating within their protocols should know that needle decompression may be needed even with vented chest seals.
10. Evacuation: Get to the hospital as quickly and safely as possible.