For open pneumothorax, what management is recommended?

• A. Apply a four-sided airtight dressing
• B. Immediate chest tube insertion before wound care
• C. Perform definitive repair in field
• D. A three-sided dressing over the wound

Answer: (D)

In open pneumothorax, the aim is to prevent air from entering the pleural space through the chest wound while still allowing air to escape if it accumulates, so you don’t develop a tension pneumothorax. A three-sided dressing achieves this by sealing the wound on three sides but leaving one side open to vent air. This creates a one-way valve effect that stabilizes breathing and reduces the risk of air buildup in the chest until definitive care can be provided. A four-sided airtight dressing would trap air inside with each breath, increasing the chance of tension pneumothorax, and chest tube insertion or definitive repair belongs in a hospital setting rather than as an initial field maneuver. So the recommended management is applying a three-sided dressing over the wound.