To pack or not to pack, that is the question...

[Submariner]

What determines which wounds are packed?

When is another dressing put over an existing dressing? Why?

Under what circumstances would a dressing be removed, packing applied and the dressing replaced? Why?

[NinjaMedic]

If it is a profusely bleeding, non-compressible wound, you pack it. If the wound for whatever reason will not receive enough pressure from a dressing then you pack it before you dress it. The whole goal is to try and deliver pressure to the damaged tissue or vessels to stop the bleeding.

My opinion is that if the dressing you are using becomes soaked and you think you messed up and should have packed it then use the soaked dressing to pack the wound and cover it with new dressings. Dont get rid of those valuable clotting factors that have soaked into the bandage.

[MIKE G]

Ninjamedic covered the bulk of it. If you have a wound that you can not provided adequate pressure to due to the depth of the wound or amount of packing material you can use a solid object. The point is to compress the vasculature to make it stop bleeding, as well as provide a matrix to help clots form.

In the civil war small canon balls were used to apply pressure deep in joints because it transmitted pressure better than macerated tissue or linen. A wad of linen would be applied and then force was applied via the ball.

You obviously do not want to pack the cranial vault. Same goes for the airway unless you can assure air movement either through a tube or manual positioning of both the patient and the packing.

If you are packing the abdomen or the chest you likely are not providing much pressure but only a matrix, consider that if you cant reach 'bottom', you may just be filling up the cavity and not exerting any force on the bleeding vessel.