Page 2 of 3 FirstFirst 123 LastLast
Results 11 to 20 of 23

Thread: Need some information Re: Chest Wounds

  1. #11
    Join Date
    Aug 2017
    Location
    Lowcountry, SC.
    Posts
    1,698
    Feedback Score
    3 (100%)
    Rather than discussing “sucking” chest wounds, I would prefer to simply divide thoracic injuries into penetrating and non-penetrating categories in the prehospital setting. I would prefer that penetrating injuries are covered or sealed prior to my arrival, with respect given to time and other priorities.

    I commonly have a response time of greater than 15 minutes, and sometimes up to 35 minutes. Our system is busy.

    I’ve seen a variety of chest seals attempted by cops and first responders. From a square of Saran Wrap, to a wrapper, to HyFin. I cannot recall any that I felt to be harmful. HMac’s experience seems to differ, and he’s probably smarter than me. Some dressings seemed effective, some less so. I’ve also seen many wounds go untreated prior to my arrival, and been mildly annoyed. You don’t necessarily need to stock and cary Halo’s or HyFins; there are other options.

    Treat the bleeding and airway first. Cut away clothes and LOOK FOR ADDITIONAL WOUNDS. Thats the number one deficiency I see. No one seems to check for additional wounds.
    RLTW

    “That is why there isn't an AK chart.” -SteyrAUG
    “They eat tide pods also so what's your point?” Retrorevolver77

  2. #12
    Join Date
    Jan 2016
    Location
    Michigan
    Posts
    212
    Feedback Score
    0
    People tend to overthink this stuff.

    In an urban, pre-hospital setting, tension pneumothrorax isn't a major concern with most EMS response times being within about 20 minutes, usually around 10 depending on the city. Nationwide average is 8.

    Now, when we get outside of say 30 min, you could start having problems. But for your average Joe, keep it towards the end of your list of concerns. Without training, it can be hard to identify vs something like flail chest etc and few people outside of experienced stateside and .mil medics have the know how to start stabbing people in the chest with 14g needles.

    Bottom line is, follow MARCH. If there is a hole in the chest, cover it. You can fake it until you make it with chest seals, but I prefer having the real thing. You can dive into the weeds with manufactured vs. improvised, vented vs non, HALO vs Hyfin etc. Bottom line is fix the problem with what you have. I prefer having vented but a chest seal is a chest seal to me.
    Worry less, Train more.

  3. #13
    Join Date
    Dec 2018
    Posts
    33
    Feedback Score
    0
    I'd say follow your local protocols. Don't get tunnel vision on a chest wound. Address it and move on...if they've got one, assume they've got more. Check the whole victim. I've arrived on scenes where a valiant effort was made addressing a single wound and multiple other injuries, some very serious, were ignored.

    In my area, we used to treat a "sucking chest wound" with 3/4 of the occlusive dressing taped down to act as a vent. Now our protocol is to fully seal it and decompress as needed.

  4. #14
    Join Date
    May 2010
    Location
    midwest
    Posts
    8,053
    Feedback Score
    4 (100%)
    Quote Originally Posted by 1168 View Post
    Rather than discussing “sucking” chest wounds, I would prefer to simply divide thoracic injuries into penetrating and non-penetrating categories in the prehospital setting. I would prefer that penetrating injuries are covered or sealed prior to my arrival, with respect given to time and other priorities.

    I commonly have a response time of greater than 15 minutes, and sometimes up to 35 minutes. Our system is busy.

    I’ve seen a variety of chest seals attempted by cops and first responders. From a square of Saran Wrap, to a wrapper, to HyFin. I cannot recall any that I felt to be harmful. HMac’s experience seems to differ, and he’s probably smarter than me. Some dressings seemed effective, some less so. I’ve also seen many wounds go untreated prior to my arrival, and been mildly annoyed. You don’t necessarily need to stock and cary Halo’s or HyFins; there are other options.

    Treat the bleeding and airway first. Cut away clothes and LOOK FOR ADDITIONAL WOUNDS. Thats the number one deficiency I see. No one seems to check for additional wounds.
    I've been doing this a long time, but my judgement of efficacy is all retrospective. My expertise is not in the field...rather, I'm the guy that the EMT's are bringing the patient to. I deal definitively with the sustained injuries, but also with the consequences of the pre-hospital treatment of those injuries. I am in awe of the level of professionalism and expertise that EMT-P's bring to bear under very challenging conditions. I know from experience that I am pretty much useless in the field. That said....I see occasional gaps, and the management of penetrating chest trauma is an area where those gaps tend to manifest themselves. In defense...I'd observe that tension pneumothorax is a very rare condition in civilian EMS, and has traditionally been a difficult subject to teach well. I have been faculty on various paramedic and tactical paramedic training courses, and have been an examiner for the state. I also have to re-certify in both CALS and ATLS every couple of years. The people that teach those courses always hate it when I'm in the class.

  5. #15
    Join Date
    Aug 2017
    Location
    Lowcountry, SC.
    Posts
    1,698
    Feedback Score
    3 (100%)
    Quote Originally Posted by Hmac View Post
    In defense...I'd observe that tension pneumothorax is a very rare condition in civilian EMS, and has traditionally been a difficult subject to teach well.
    To clarify my perspective, the county I put in most of my work in is the size of Rhode Island. I get about half of my GSW’s on the end of the county thats an hour ride at 80mph from the nearest trauma center. About a quarter are 30 minute rides and the other quarter are 5-10 minute rides. Have not observed a tension pneumothorax building in 5 minutes.

    Also, the vast majority of GSW’s I treat are one or two wounds, so I get through treatment priorities fast. Stabbings are a different story....
    RLTW

    “That is why there isn't an AK chart.” -SteyrAUG
    “They eat tide pods also so what's your point?” Retrorevolver77

  6. #16
    Join Date
    Jul 2006
    Location
    Midwest, USA
    Posts
    7,851
    Feedback Score
    1 (100%)
    Quote Originally Posted by Hmac View Post
    I've been doing this a long time, but my judgement of efficacy is all retrospective. My expertise is not in the field...rather, I'm the guy that the EMT's are bringing the patient to. I deal definitively with the sustained injuries, but also with the consequences of the pre-hospital treatment of those injuries. I am in awe of the level of professionalism and expertise that EMT-P's bring to bear under very challenging conditions. I know from experience that I am pretty much useless in the field. That said....I see occasional gaps, and the management of penetrating chest trauma is an area where those gaps tend to manifest themselves. In defense...I'd observe that tension pneumothorax is a very rare condition in civilian EMS, and has traditionally been a difficult subject to teach well. I have been faculty on various paramedic and tactical paramedic training courses, and have been an examiner for the state. I also have to re-certify in both CALS and ATLS every couple of years. The people that teach those courses always hate it when I'm in the class.
    Doc- Can you say more about the gaps? What should we be doing and teaching differently for penetrating chest injuries to cover those gaps? Differentiated for lay, trained non-EMS, BLS, and ALS providers as applicable.
    2012 National Zumba Endurance Champion
    الدهون القاع الفتيات لك جعل العالم هزاز جولة الذهاب

  7. #17
    Join Date
    Feb 2011
    Posts
    1,774
    Feedback Score
    73 (100%)
    I appreciate all the responses.

    I’m not sure if it helps, but my concern would be for blast/fragmentation injuries, followed closely by burns.

    Depending on the extent of the event, it could take up to 30 minutes just to have medical cleared to come to our location. We have medivac flight available at moments notice. However, situation dictates, the site still needs to be secured and the incident needs to be cleared.

  8. #18
    Join Date
    Dec 2009
    Location
    Florida Gulf Coast
    Posts
    1,428
    Feedback Score
    5 (100%)
    Quote Originally Posted by davidjinks View Post
    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?
    I think something may have been miscommunicated there. I believe what was meant here is that your priority is to control bleeding because the likelihood of you needing to worry about tension pneumo prior to EMS arrival is fairly low. Tension pneumothorax doesn't happen instantly. Unless you're in a very rural setting and EMS is 20+ min away, you're unlikely to ever be dealing with a tension pneumo as a first responder. That being said, a chest wound should be initially treated with direct pressure from a gloved hand followed by an occlusive dressing of some type asap. By getting a gloved hand and an occlusive dressing on there as soon as possible you're less likely to have to deal the patient even developing symptoms before arriving at the ER. If EMS is dispatched immediately and you live in an area with low EMS response times with appropriate hospitals close by, chances are the patient is being seen by a physician before a tension pneumo starts to set in. Now if you're working out west in Montana, Wyoming, Idaho, Alaska etc that's a different story. If you don't have a chest seal of some kind available the best thing you can do for for a patient with a chest wound as a first responder is slap a gloved hand on that bleedy boi and wait for uber to get there.

    Ultimately what saves lives is rapid dispatch, large amounts of diesel fuel and physicians. Don't over complicate it. You're not going to save Shauntavious Quantavious Demetrius IV by darting his chest two minutes before the ambulance drivers get there.

  9. #19
    Join Date
    Mar 2010
    Location
    Durham, NC
    Posts
    3,444
    Feedback Score
    19 (100%)
    I will preface this to say I have not seen everything and I do not know everything. That said, I have been in the field/OOH/pre-hospital biz in some form or fashion since 1990. I have never, ever seen a thoracic trauma patient in a civilian EMS setting that developed a tension pneumo. I HAVE seen delayed care/poor prioritization for slapping on occlusive dressings to wounds that likely did not need them.

    Cover and dress with traditional methods and move on, but follow local protocols.

  10. #20
    Join Date
    Jul 2006
    Location
    Midwest, USA
    Posts
    7,851
    Feedback Score
    1 (100%)
    Oooh, "protocol." No news to some of us, but worth mentioning to others learning.

    Protocols govern regulated providers in regulated environments, not lay rescuers. See also: standing orders. Pre-hospital treatment protocols can vary widely between med directors, services, and within systems. Everybody has a standard of care though. Due to quirks of statute, in some places a lay provider may have a greater scope of practice than a trained provider. And even if within a scope of practice, a protocol may prohibit certain actions by regulated providers as they can be more restrictive but not more permissive. Thinking back over the years, there have been some fun quirks with glucose meters, epi pens, combi-tubes and kings, tourniquets, hemo gauze and wound packing, and more lately narcan/naloxone administration. At the time of quirk, lay rescuers could do all of those things.

    Local protocols are still a useful reference point for lay providers those teaching same. Much like your local LE choices in gear/ammo, it can be useful to be able to point to your local professional rescuers and note that you're doing what they're doing.

    Words are fun sometimes.
    2012 National Zumba Endurance Champion
    الدهون القاع الفتيات لك جعل العالم هزاز جولة الذهاب

Page 2 of 3 FirstFirst 123 LastLast

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •