A 45-year-old male stabbed in the left anterior chest; along with high-flow oxygen, what should you do?

• A. Suspect a tension pneumothorax and notify the trauma center as soon as possible.
• B. Control the bleeding from the stab wound with a sterile porous dressing and reassess vital signs.
• C. Perform a detailed physical exam at the scene.
• D. Cover the stab wound with an occlusive dressing, support ventilation as needed, and transport rapidly.

Answer: (D)

The main idea is to prevent air from entering the chest cavity while ensuring adequate ventilation and getting the patient to definitive care quickly. A penetrating chest wound can allow air to be drawn into the pleural space during inspiration, which can lead to a pneumothorax and, if it worsens, a life-threatening tension pneumothorax. Sealing the wound with an occlusive dressing creates a barrier that stops air from entering the chest, reducing the risk of a deteriorating pneumothorax. At the same time, you maintain ventilation support as needed to keep oxygen delivery adequate, using bag-valve-mask ventilation or other airway support if the patient shows signs of respiratory distress. Rapid transport is essential because this type of injury can worsen quickly and requires definitive care. While controlling external bleeding is important, a porous dressing would not prevent air from entering the chest, and spending time on a detailed exam at the scene can delay life-saving treatment. If signs of tension pneumothorax develop, treat that immediately, but the immediate priorities are occlusion of the chest wound, ventilation support, and rapid transport.