Which initial management step is appropriate for a patient with an open chest wound?

• A. Apply a rigid chest splint
• B. Cover with an occlusive dressing taped on three sides
• C. Schedule imaging
• D. Administer diuretics

Answer: (B)

When a patient has an open chest wound, the priority is to seal the chest to prevent air from being drawn into the pleural space while still allowing trapped air to escape. The best initial step is to place an occlusive dressing over the wound and secure it on three sides. This creates a flutter-valve effect: air can exit the chest during exhalation, but external air entry is limited during inhalation, reducing the risk of developing a tension pneumothorax. After sealing, reassess frequently, provide high-flow oxygen if available, and transport promptly. Other approaches like applying a rigid chest splint, delaying for imaging, or giving diuretics do not address the open wound or could worsen the patient’s condition.