The lung injury to worry about is the tension pneumothorax--air escaping from the lung and building up pressure in the chest until blood cannot return to the heart. Injudicious use of an occlusive dressing can convert an ordinary collapsed lung into a tension pneumo. You want a dressing that will let air out of the hole in the chest but not back in. Anyone who is going to treat an open chest wound needs to understand tension ptx, how to recognize it, and what to do about it.
Also, even if the lung is not punctured, completely occluding the hole so that air can neither get out or in doesn't reexpand the lung. In order to reexpand air has to be able to leave the chest during the positive pressure phase of respiration (expiration) but not get back in during the negative pressure phase--inspiration.
Anyone fit enough to be recreating in the backcountry should be able to tolerate an open chest wound and collapse of one lung.
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