What Is a Chest Seal?
A chest seal is a sterile, occlusive (airtight) adhesive dressing applied over a penetrating chest wound to prevent air from entering the pleural space—the thin, fluid-filled cavity between the lungs and the chest wall.
When a penetrating object (such as a bullet or a knife) breaches the chest wall, it bypasses the body’s natural airway (the trachea). As the patient inhales, air enters directly into the pleural cavity rather than into the lungs. This condition, known as a pneumothorax (collapsed lung), prevents the lung from expanding and oxygenating the blood. Without intervention, it can rapidly progress to a tension pneumothorax, which is a life-threatening condition where trapped air builds up such high pressure that it pushes the heart to one side and collapses the remaining lung. This can lead to cardiac arrest and death in minutes. The Asherman Chest Seal, introduced in 1974, was the first widely adopted medical device for this purpose.
Does It Stop Bleeding?
No. A chest seal does not stop bleeding. Its sole function is to create an airtight barrier so that the patient can breathe normally. A sucking chest wound requires concurrent efforts to control external hemorrhage (with direct pressure and a hemostatic dressing if necessary), but the chest seal itself is for respiratory management, not bleeding control.
How Does a Chest Seal Work?
When a penetrating injury occurs to the chest, back, or upper abdomen, any wound in that region is considered a potential life-threatening chest injury until proven otherwise. You must check the entire torso for entry and exit wounds—penetrating trauma is often bilateral. A single chest seal is rarely enough; a twin pack allows you to seal both the entry and exit wounds simultaneously.
Step-by-Step Application
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Expose the wound. Remove clothing and debris from the chest area.
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Control gross bleeding with direct pressure first, but do not probe the wound.
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Wipe the surrounding skin dry using the gauze provided with the seal. Adhesion is critical, and moisture (blood, sweat, dirt) is the enemy of a good seal.
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Peel the backing from the adhesive side of the chest seal.
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Apply the seal directly over the wound, ideally just as the patient exhales. This minimizes the amount of air already trapped in the chest.
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Press firmly around all edges of the seal to ensure an airtight bond.
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Monitor the patient closely for any signs of developing tension pneumothorax, such as increased respiratory distress, absent breath sounds on the affected side, or tracheal deviation (windpipe shifting away from the wound).
