CHEST WOUNDS.\All chest injuries are serious. They can cause severe breathing and bleeding problems. Any casualty showing signs of difficulty in breathing without signs of airway obstruction must be inspected for chest injuries. One of the most serious chest injuries is the sucking chest wound. This is a penetrating injury to the chest that produces a hole in the lung, causing the lung to collapse, and thus preventing normal breathing. Immediate medical aid must be provided. The sucking chest wound will result in death if not treated quickly.

A casualty with an open chest wound gasps for breath, has difficulty breathing out, and may have a bluish or grayish color to his face. When you remove clothing over the area, you may or may not hear a sucking sound at the wound site. Frothy blood may bubble from the wound during breathing.

To treat a casualty of a sucking chest wound:

1. Remove any clothing from the chest area.

2. Immediately seal the wound with your hand or any nonporous (airtight) material such as aluminum foil or plastic wrap (cellophane).

3. Wipe the blood from the surrounding skin while holding the airtight material over the wound. Apply tape (wide and nonporous, if possible) to all sides of the material, leaving one corner of the dressing unsealed.

This procedure allows trapped air to escape when the casualty exhales and prevents air entry when the casualty inhales.

4. Give the casualty oxygen if it is available. If a lung is injured, more oxygen will be needed to compensate for the injury.

5. Place the casualty on the wounded side unless there is back injuries. By placing the patient on the wounded side, you will keep the good lung up so breathing will be easier. If the casualty is having difficulty breathing while on the wounded side, you can place him/her in a sitting position. This may help to make breathing easier.

6. Watch the casualty closely for signs of respiratory difficulty or shock. Treat accordingly.

7. Do not give a casualty with chest injuries anything to eat or drink.

8. Immediately transport the casualty, wounded side down, to a medical facility.

The procedures described above are also followed when treating a lung injury from the casualty's back.

ABDOMINAL WOUNDS.\Many vital organs are located in the abdominal area, so a deep wound in the abdomen is likely to constitute a major emergency. Abdominal wounds usually cause intense pain, nausea and vomiting, spasms of the abdominal muscles, and severe shock. Immediate surgical treatment is almost always required, so the casualty must receive medical attention at once. Give only the most essential treatment, and concentrate your efforts on getting the casualty to a medical facility.

The general procedures for treating an abdominal wound are as follows:

1. Keep the casualty lying on his/her back. If the intestine is protruding or exposed, the patient may be more comfortable with the knees drawn up. Place a coat, a pillow, or some other bulky cloth material under the knees to help maintain this position. Do not attempt to push the intestines back in or to manipulate them in any way. Do not try to clean dirty intestines; this will be done thoroughly at the hospital.

2. If the intestine is not exposed, cover the wound with a dry, sterile dressing. If the intestine is exposed (fig. 13-10), apply a sterile bandage moistened with sterile water. If no sterile water is available, clean sea water or any water that is fit to drink may be used to moisten the bandage. The bandage should be large enough to cover the wound and the surrounding area.

Figure 13-10.\Exposed intestine.

Fasten the bandage firmly so that the dressing will not slip around, but do not apply more pressure than is necessary to hold the bandage in position. Ideally, the dressing should be folded under and then over the intestines (envelope style).

3. Apply an occlusive material such as aluminum foil or plastic wrap over sterile dressing and secure in place with tape or other material. This will help keep the sterile dressing moist.

4. Treat for shock. The casualty must be taken to a medical facility at the earliest opportunity. Do not give the patient anything to eat or drink. If he/she complains of great thirst, moisten the lips with a small amount of water, but do not allow the patient to swallow.

Summary of Wounds

Although it is not always necessary to know what agent or object caused a wound, it is often helpful because it may give you some idea of the probable size of the wound, its general nature, the extent to which it is likely to be contaminated with foreign matter, and what special dangers must be guarded against.

The emergency treatment for all wounds consists mainly of stopping the flow of blood, treating for shock, and preventing infection.

For a casualty with multiple wounds, first treat the wound that appears to be most life-threatening. Be sure to check all possible points of the body for injury.

Your first concern is to stop the bleeding, preferably by direct pressure, elevation, or the use of pressure points. A tourniquet should be used only if the other methods do not control the bleeding.

Do not spend undue time trying to clean a dirty wound. This will be done by medical personnel. But, apply a dressing to help prevent additional contamination of the wound.

If a foreign object is near the surface and exposed, you may remove it. But if the injury is caused by a knife or other object that is still embedded, do not remove the object. It may cause massive bleeding. Simply apply dressings around the object.