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
🆓 This is a free MCQ — click below to view the answer.
✅ Correct Answer: D) Apply a three-sided occlusive dressing to the wound
Explanation: This is a classic open pneumothorax (sucking chest wound). When the defect is ≥2–3 cm, air enters the pleural cavity preferentially, impairing ventilation.
Management:
- First: Apply a three-sided occlusive dressing. This allows air to escape on exhalation but prevents entry during inhalation, avoiding tension pneumothorax.
- Then: Insert a chest tube on the same side before sealing the wound completely.
Why others are incorrect:
A) Airtight closure before chest tube risks tension pneumothorax.
B) Chest tube insertion is essential but follows the temporary dressing.
C) Intubation may be required later, but immediate chest wound control is priority.
