Examples of Partially Occlusive Dressings for Tension Pneumothorax
For tension pneumothorax management, breathable chest pads or conventional chest pads secured on three sides (leaving one side open) are the recommended partially occlusive dressings to allow air to escape while preventing additional air entry. 1
Recommended Partially Occlusive Dressing Options
Primary Options:
- Breathable chest pad - specifically designed for chest wounds 1
- Conventional chest pad taped on three sides only - creating a one-way valve effect 2
- Vented chest seal - specialized dressing with built-in valve mechanism 1
- Clean, non-occlusive dry dressing (e.g., gauze dressing or part of a t-shirt) 1
Application Technique:
- Place dressing over the open chest wound
- Secure on three sides only, leaving one side untaped
- This creates a "flutter valve" effect that:
- Allows air to escape during exhalation
- Prevents air entry during inhalation
- Reduces risk of tension pneumothorax development
Evidence-Based Management Principles
The 2015 International Consensus on First Aid Science and the 2024 AHA/American Red Cross guidelines strongly recommend against fully occlusive dressings for open chest wounds 1. This recommendation is based on evidence that fully occlusive dressings increase the risk of tension pneumothorax development.
Key management principles:
- Leave one side of the dressing unsealed to allow air to escape 2
- Monitor closely for signs of tension pneumothorax development 1
- If breathing worsens after dressing application, immediately loosen or remove the dressing 1
- Be prepared to "burp" the dressing by temporarily lifting one edge if respiratory distress increases 2
Warning Signs Requiring Immediate Intervention
After applying a partially occlusive dressing, monitor for:
- Progressive hypoxia
- Increasing respiratory distress
- Hypotension
- Decreasing breath sounds on the affected side
- Tachycardia and restlessness
If these signs develop, the dressing should be immediately removed or loosened, and emergency services should prepare for needle decompression if authorized 1.
Practical Considerations
- In battlefield or emergency settings, if specialized dressings aren't available, a clean piece of clothing can serve as a partially occlusive dressing 1
- The 2024 AHA/American Red Cross guidelines note that it is reasonable to leave an open chest wound exposed to ambient air if no appropriate dressing is available 1
- Monitor the patient continuously after dressing application
- Remember that the primary goal is to prevent air entry while allowing air to escape
This approach balances the need to seal the chest wound against the risk of creating a life-threatening tension pneumothorax, prioritizing patient survival and respiratory function.