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In rare cases, sealing the wound may cause the patient to have increased difficulty breathing. If a patient has more difficulty breathing after you seal the wound, uncover one corner of the occlusive dressing to see if breathing will improve. Administer oxygen if it is available and you are trained to use it. If a knife or other object is impaled in the chest, do not remove it. Seal the wound around the object with a dressing to prevent air from entering the chest. Stabilize the impaled object with bulky dressings.
A chest injury that results in air leakage and bleeding requires prompt attention. For these reasons, patients with severe chest injuries should be transported rapidly to an appropriate medical facility. A conscious patient with chest trauma may demand to be placed in a sitting position to ease breathing. Unless you must immobilize the spine or treat the patient for shock, help the patient assume whatever position eases breathing.
If oxygen is available, administer it. If the patient's respirations are excessively slow or absent, perform mouth-to-mouth breathing. A mouth-to-mask device or a bag-valve mask may also be used by trained personnel. If the heart stops, begin chest compressions, regardless of whether there are chest injuries.
Garry Briese is the executive director of the International Association of Fire Chiefs (IAFC) and, along with David Schottke, co-author of the new edition of First Responder: Your First Response In Emergency Care, available in summer 1996 from Jones & Bartlett Publishers. The book is produced by the American Academy of Orthopaedic Surgeons and the National Safety Council.