A male patient has a sucking stab wound to the chest. Which action should the nurse take first?
A. Drawing blood for a hematocrit and hemoglobin level.
B. Applying a dressing over the wound and taping it on three sides.
C. Preparing a chest tube insertion tray.
D. Preparing to start an I.V. line.
Correct Answer: B. Applying a dressing over the wound and taping it on three sides.
The nurse immediately should apply a dressing over the stab wound and tape it on three sides to allow air to escape and to prevent tension pneumothorax (which is more life-threatening than an open chest wound). The nurse may use a first aid device called a chest seal or improvise with the packaging sterile dressings coming in. Peel open the packaging and tape the entire plastic portion over the wound.Only after covering and taping the wound should the nurse draw blood for laboratory tests, assist with chest tube insertion, and start an I.V. line.
Option A: Initial assessment to determine whether the patient is stable or unstable dictates further evaluation. If the patient is hemodynamically unstable and in acute respiratory failure, bedside ultrasound should be performed to confirm the diagnosis if it is available for immediate use. When a patient is hemodynamically stable, radiographic evaluation is recommended. The initial assessment is with a chest radiograph (CXR) to confirm the diagnosis.
Option C: Chest tubes are usually managed by experienced nurses, respiratory therapists, surgeons, and ICU physicians. In 90% of the cases, a chest tube is sufficient; however, there are certain cases where surgical interventions are required, and that can either be video-assisted thoracoscopic surgery (VATS) or thoracotomy.
Option D: Tension and traumatic pneumothoraces are usually managed in the emergency department or the intensive care unit. Management strategies depend on the hemodynamic stability of the patient. In any patient presenting with chest trauma, airway, breathing, and circulation should be assessed.
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