For a casualty with a suspected open chest wound showing signs of a sucking chest wound, what is the priority?

• A. Apply a standard gauze dressing
• B. Apply an occlusive dressing sealed on three sides and monitor for deterioration
• C. Leave wound unsealed to vent
• D. Apply a tourniquet above the wound

Answer: (B)

Open chest wounds that show a sucking sound or air leakage create a risk of air being drawn into the chest cavity during inhalation, which can lead to a tension pneumothorax. The priority is to seal the wound in a way that prevents air from entering but still allows air to escape if pressure builds. An occlusive dressing taped on three sides does exactly this: it forms a tight seal around the wound on three edges while leaving one edge unsealed to vent. This flutter-valve effect lets air escape during exhalation but limits entry during inhalation, reducing the risk of increasing pressure in the chest. It also protects the wound from contamination. In contrast, a standard gauze dressing, a fully unsealed wound, or a tourniquet would not address the chest cavity dynamics in this scenario. After applying the three-sided seal, monitor the casualty for any signs of deterioration, and seek advanced care if symptoms worsen.