Q) A 30-year-old male presents to the emergency department after a stab wound to the right chest. On examination, there is a 4 cm open wound in the 5th intercostal space anteriorly, with a sucking sound during inspiration, decreased breath sounds on the right, and respiratory distress. What is the next best step in management? # Theme neet ss mocktest 1
A. Immediately close the wound with an airtight dressing B. Insert a chest tube on the same side and then close the wound C. Intubate and initiate positive pressure ventilation D. Apply a three-sided occlusive dressing to the wound
D. Apply a three-sided occlusive dressing to the wound
This is a classic presentation of an open pneumothorax, also known as a sucking chest wound. When the chest wound is ≥2–3 cm (or ≥2/3 the diameter of the trachea), air preferentially enters through the chest wall defect instead of the trachea, impairing ventilation.
Management steps:
Initial step: Apply a three-sided occlusive dressing — this allows air to escape during exhalation but prevents air from entering during inhalation, avoiding tension pneumothorax.
Definitive step: Place a chest tube (thoracostomy) on the same side before fully sealing the wound.
A is incorrect because a fully sealed dressing without a chest tube can cause tension pneumothorax. B is correct only after the initial temporary occlusive dressing is applied. C may be needed later but not before securing the wound.
