What is the first step in the management of an open pneumothorax?

In the management of an open pneumothorax, the priority is to prevent further air from entering the pleural space while allowing trapped air to escape. Applying a three-sided dressing effectively accomplishes this by creating a seal over the wound that allows air to escape during expiration but prevents air from entering during inspiration. This technique reduces the risk of tension pneumothorax, a life-threatening complication where increased pressure in the pleural cavity collapses the lung and shifts mediastinal structures.

The rationale for prioritizing this step lies in the urgency of stabilizing the patient’s airway and preventing further respiratory compromise. While oxygen administration is crucial for all patients with respiratory distress, it does not address the immediate mechanical problem caused by the open wound. Inserting a chest tube can be necessary later in the treatment process, but it is not the first step because it requires additional preparation and is not an immediate solution to prevent air entry. Performing a thorough physical exam, while important for overall assessment, does not directly address the life-threatening nature of the open pneumothorax and can delay crucial interventions.