In my carrier I have treated several penetrating chest wounds from knives and hand gun rounds. None of these resulted in a true tension pneumothorax. None of the gun shot wounds to the chest were through and through with an entrance and exit wound except for one. The "lucky" gang banger was hit in the right front of the chest with a 45 acp at close range and the bullet penetrated the skin and followed the rib cage exiting around the back side approximately 10" from the entrance wound. I assumed that this was most likely a FMJ round although the projectile was not found. He suffered a broken rib but no penetration into the plural cavity. Our protocol was that any penetrating injury from the clavicle to the diaphram was to be sealed and the patient monitored for signs of a developing peumothorax. Chest wounds from a rifle round wound be a different story with a bullet diameter entrance wound and a larger exit wound depending on bullet caliber, speed and design. I only carry chest seals in a combat medic bag, my IFAKs carry two oclusive dressings for penetrating chest wounds as well as wound packing material and pressure dressings, TK, nasal airways with lube pack and a triangular bandage.
