If an open neck wound is covered with an occlusive dressing and signs of tension pneumothorax develop, what should you do first?

• A. Lift the unsecured corner of the dressing to allow air to escape.
• B. Add another occlusive layer over the dressing.
• C. Remove the entire dressing.
• D. Provide airway ventilation.

Answer: (A)

An open chest wound covered with an occlusive dressing can trap air and, if air continues to enter the pleural space, create tension pneumothorax. When signs of tension develop, the immediate priority is to relieve that pressure. Lifting an unsecured corner of the dressing to vent air provides a quick outlet for trapped air, reducing intrathoracic pressure and helping restore breathing and circulation without removing the wound protection. Adding another occlusive layer would seal air in and worsen the tension, and removing the entire dressing would compromise the wound seal and increase contamination risk. While maintaining airway and breathing is essential, venting the chest comes first to prevent rapid deterioration.