During the rapid head-to-toe assessment of a patient with multiple injuries, you expose the chest and find an open wound with blood bubbling from it. You should:

• A. Place a porous dressing over the wound.
• B. Apply high-flow supplemental oxygen.
• C. Prevent air from entering the wound.
• D. Stop your assessment and transport.

Answer: (C)

A chest wound that is open and bubbling acts like a sucking chest wound, where air can be drawn into the chest with each inhale. The immediate, life-saving action is to stop air from entering the chest by sealing the wound with an occlusive dressing. Secure the dressing firmly over the wound, ideally taping on several sides so air cannot be sucked in, while still allowing trapped air to escape if needed. This prevents the developing pneumothorax from worsening and reduces the risk of a tension pneumothorax during ventilation.

Providing high-flow oxygen is important for overall oxygenation, but it does not address the leak into the chest cavity, which is why preventing air entry is the priority. Stopping the assessment and transport isn’t appropriate; treat and rapidly transport to definitive care. A porous dressing would fail to seal the wound and would not prevent air entry.