Pneumothorax first aid

Question

I've heard a questionable advice about open pneumothorax first aid from a school nurse and would like to ask if it is legit. I do see the reasoning behind it but it seems like attempting such thing could go horribly wrong.

When i googled about pneumothorax first aid it just says that you should cover the hole (wound) with something that would not allow air to go through while the injured person has his/her chest compressed (breath out). So that when he/she tries to take a breath in the lung will be open by decreased pressure in the chest instead of sucking air through the hole.

However the advice i've heard was to go a step further and create an improvised valve that would let air out but not inside. This is achieved by placing some material that does not let air go through over the hole but only fixing the top side of it.

So when the pressure inside injured person's chest is lowered this bandage would be pressed onto the hole by the air outside and close it.

But when the air/fluid wants to escape through the hole it would go freely.

And in case of absolute emergency and lack of better options she said we can use a credit card for it (as a flap).

The question is:

• could it theoretically work?
• if it could work at least theoretically, how much better would it be than ordinary airtight bandage?
• should a person without medical education attempt it?
• would a person with medical education attempt it?
• what could go wrong and what are the chances?

Answer 1

As Narusan pointed out, a simple pneumothorax isn't generally life threatening, and there's nothing a layman can do about a closed pneumothorax other than summon EMS and comfort the patient.

When EMS arrives, if they're trained at the basic EMT level and therefore don't have chest decompression skills, they will treat an open pneumothorax in a way similar to what you described in your question. (Paramedics generally have the ability to do chest decompressions, at least in the US.)

Basically, they'll create a one-way "flap valve" using vaseline gauze or materials at hand. The procedure is to place the gauze or a piece of plastic wrap over the wound. The gauze or wrap is then taped down on three sides, leaving one side unsecured. This allows air to be expelled but prevents air from being sucked in, exactly as you proposed.

However, as my link notes, open tension pneumothoraces are rarely tidy. When holes get punched in the chest there's likely to be blood, dirt, a combative patient, and the wound may be too large for such a simple solution. It would be an incredibly rare circumstance where a layman might actually apply such first aid successfully.

https://www.ems1.com/ems-products/medical-equipment/airway-management/articles/957467-Tension-Pneumothorax-Identification-and-treatment/

Answer 2

A pneumothorax in an otherwise healthy patient is not life threatening. In both open and closed form, the air gets in and out, so pressure does Not built up. Call 911 and perform standard procedures without thinking about the pneumothorax per we, but including checking breathing et cetera.

A tension pneumothorax is life-threatening. In this version, the pressure does built up because the wound acts as a valve, not leaving air out. This can lead to a collapse of a lung wing.

The standard medical procedure of treating a tension pneumothorax is needle chest compression. Basically, you want to create another hole to let the air in and out and solving the valve issue (in fact, you are degrading the tension pneumothorax to a pneumothorax and a hole in the torso). This is a professional procedure and should not be performed by non-professionals. You have to get to the right intercostal space (otherwise you might end up puncturing the heart), you need sterile equipment and so on.

There is the Good Samaritan Law but I highly doubt it would cover punching holes into people and risking infections, sever injuries etc. I doubt that professionals without equipment would use credit cards or else.