Open Pneumothorax

Also known as a “sucking” chest wound, an open pneumothorax results from penetrating chest trauma and creates an air passage from the environment into the thoracic cavity. Depending on the size of the wound, air can become preferentially entrained into the pleural space, causing ipsilateral lung collapse. If air can enter the thoracic cavity but is prevented from exiting (by tissue valve effect) a tension pneumothorax can rapidly develop.


Clinical signs

  • Usually clinically obvious
    • Bubbling/sucking from a penetrating chest wound
  • Associated respiratory distress, tachypnoea, hypoxia
  • Decreased breath sounds on affected side, signs of tension pneumothorax



  • Oxygen to maintain saturations >92%
  • Place an occlusive dressing over the wound
Traditionally a 3 -sided flutter dressing was advocated, but a recent review by the UK NICE team have shown there is no evidence for this practise1


Disposition – interhospital transfer guidelines

open pthx destination



  1. Major trauma: assessment and initial management. NICE guideline. Published: 17 February 2017


Neck Trauma Guideline: Blunt neck (cerebrovascular) trauma

About this guideline

Published: February 2018
Author: Emma Batistich
Updated: Sue Johnson April 2021
Approved by: Northern Region Trauma Network, ADHB, WDHB, CMDHB, NDHB, NRHL, St. John
Review due: 2 years