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Thread: Need some information Re: Chest Wounds

  1. #1
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    Need some information Re: Chest Wounds

    I just went through my recert for emergency first responder training.

    When going over wound care/stop the bleed, the topic of sucking chest wounds came up. The directive we were given was to control bleeding and NOT seal the chest wound. The idea is that we control the bleed and that there will be enough time for EMS to get there before we start being concerned with tension pneumothorax.

    I disagreed with that and stated I would go into bleed control and then sealing the chest wound if it was indeed a sucking chest wound.

    Can anyone add any their thoughts on this?

    Is it good to just control the bleed, stabilize and wait or get to it and seal the wound if needed?

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    When you get to the B in H-ABC, the most clinically appropriate thing to do would be to seal it. At least get a gloved hand over it. Continue checking for other wounds.

    I do not prefer to arrive at a shooting and five people with gloves on are staring at an open hole in the chest.

    Its important to note that I did not write your local protocols, so act appropriately in accordance with your organization’s policies.
    RLTW

    Former Action Guy
    Disclosure: I am affiliated PRN with a tactical training center, but I speak only for myself. I have no idea what we sell, other than CLP and training. I receive no income from sale of hard goods.

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    Agreed. It’s pretty easy to slap a piece of something on the to seal it. Don’t have to worry about chest farts or anything at your level but if protocols allow, plastic or a Vaseline gauze or best yet a real chest seal can save a life.


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    Quote Originally Posted by davidjinks View Post
    When going over wound care/stop the bleed, the topic of sucking chest wounds came up. The directive we were given was to control bleeding and NOT seal the chest wound. The idea is that we control the bleed and that there will be enough time for EMS to get there before we start being concerned with tension pneumothorax.
    What your instructor likely meant was that a tension pneumo is a later threat, and may not occur within your local EMS response time. If that's the case, they were right.

    Once priorities were handled, I would apply a manufactured or improvised chest seal. Note that chest seals aren't a topic in the STB curriculum.

    This is a topic many classes can get bogged down on. "Chest" seals vs the circumference of the thorax between the landmarks, vented or not, manufactured or improvised. For many students, time is better spent on learning on bleeding control, maintaining an open airway, recovery position. When I teach it to a lay class, I explain to put the body back like it was (sealed) with whatever they've got, and fart when you need to.
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    Good lord, the mystery of "sucking chest wounds".

    Do yourself (and your patient) a favor...don't overthink. You can address the "sucking chest wound" after you're sure that you've addressed all of the potentially more urgent problems. Mishandling a "sucking chest wound" is likely to do more harm than good.
    Last edited by Hmac; 11-23-19 at 19:13.

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    Quote Originally Posted by Hmac View Post
    Good lord, the mystery of "sucking chest wounds".

    Do yourself (and your patient) a favor...don't overthink. You can address the "sucking chest wound" after you're sure that you've addressed all of the potentially more urgent problems. Mishandling a "sucking chest wound" is likely to do more harm than good.
    Will you please elaborate in detail as to the specific things that you refer to as "mishandling?"

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    Quote Originally Posted by LMT Shooter View Post
    Will you please elaborate in detail as to the specific things that you refer to as "mishandling?"
    Automatically slapping some kind of occlusive dressing, maybe with some kind of overly-elaborate valve mechanism, without having an understanding of respiratory physiology, the physiology of pneumothorax, nor chest anatomy. So focused on the one wound that other more important injuries are mis-prioritized or missed altogether.
    Last edited by Hmac; 11-24-19 at 09:25.

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    Quote Originally Posted by Hmac View Post
    Automatically slapping some kind of occlusive dressing, maybe with some kind of overly-elaborate valve mechanism, without having an understanding of respiratory physiology, the physiology of pneumothorax, nor chest anatomy. So focused on the one wound that other more important injuries are mis-prioritized or missed altogether.
    Gotcha, thanks.

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    I appreciate the responses.

    HMAC, I understand what you are saying.

    Quote Originally Posted by 1168 View Post
    When you get to the B in H-ABC, the most clinically appropriate thing to do would be to seal it. At least get a gloved hand over it. Continue checking for other wounds.

    I do not prefer to arrive at a shooting and five people with gloves on are staring at an open hole in the chest.

    Its important to note that I did not write your local protocols, so act appropriately in accordance with your organization’s policies.
    Quote Originally Posted by ST911 View Post
    What your instructor likely meant was that a tension pneumo is a later threat, and may not occur within your local EMS response time. If that's the case, they were right.

    Once priorities were handled, I would apply a manufactured or improvised chest seal. Note that chest seals aren't a topic in the STB curriculum.

    This is a topic many classes can get bogged down on. "Chest" seals vs the circumference of the thorax between the landmarks, vented or not, manufactured or improvised. For many students, time is better spent on learning on bleeding control, maintaining an open airway, recovery position. When I teach it to a lay class, I explain to put the body back like it was (sealed) with whatever they've got, and fart when you need to.
    Quote Originally Posted by Hmac View Post
    Good lord, the mystery of "sucking chest wounds".

    Do yourself (and your patient) a favor...don't overthink. You can address the "sucking chest wound" after you're sure that you've addressed all of the potentially more urgent problems. Mishandling a "sucking chest wound" is likely to do more harm than good.

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    I have been taught that a penetrating injury between the clavicle and navel get an occlusive dressing. We generally practice load and Go's and will meet Medics en route if need be. Depending on the jobsite I'm anywhere between. 10 minutes to 25 minutes to around the corner. Depends.

    So this begs the question, do we keep carrying and worrying about occlusive dressings and chest wounds or go back to packing wounds and holding pressure?

    Would love to hear from the medical professionals. My experience with traumatic injury is limited and have never personally observed a "sucking chest wound."

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