Page 3 of 3 FirstFirst 123
Results 21 to 23 of 23

Thread: Need some information Re: Chest Wounds

  1. #21
    Join Date
    Mar 2010
    Location
    Durham, NC
    Posts
    3,444
    Feedback Score
    19 (100%)
    Quote Originally Posted by ST911 View Post
    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.
    Protocols. Guidelines. SOPs. TTPs. Policies. Procedures. Ugh, don't get me started on this word salad and the subconscious reflex to get an attorney to make me sure I keep my license.

  2. #22
    Join Date
    May 2010
    Location
    midwest
    Posts
    8,053
    Feedback Score
    4 (100%)
    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.
    Whereas I think the clinically appropriate thing to would be to assess the patient and determine whether or not the wound is clinically relevant. The wound isn't the problem. The physiological effect of the wound is the problem. Is the patient ventilating? Oxygenating? Is there JVD? Tracheal deviation? BP? Heart rate? Those things all go into the decision matrix as to how that wound is managed in the field and are more important than the mere fact that there is a chest wound.

  3. #23
    Join Date
    Mar 2014
    Posts
    93
    Feedback Score
    0
    Quote Originally Posted by Hmac View Post
    Whereas I think the clinically appropriate thing to would be to assess the patient and determine whether or not the wound is clinically relevant. The wound isn't the problem. The physiological effect of the wound is the problem. Is the patient ventilating? Oxygenating? Is there JVD? Tracheal deviation? BP? Heart rate? Those things all go into the decision matrix as to how that wound is managed in the field and are more important than the mere fact that there is a chest wound.
    This is where "protocol" and context become difficult to navigate, and there isn't a definitive answer. Those of us with some experience in the medical community (either in EMS/prehospital settings or in definitive care settings), no matter what level of experience or expertise have all probably fallen into the paradox of "well if I choose this intervention based upon what signs/symptoms I am seeing, it might deviate from a textbook protocol... BUT IT WILL PROVIDE A BETTER PATIENT OUTCOME and greater chance of survivability." This calculus is nearly entirely based on a sound assessment of a real patient and the hierarchies found within provision of care based upon what you are observing.

    I would say that a good bet is to follow local/your agency's SOPs, and follow whichever acronym they have adopted, but recognize that others exist and that there are nuances between them. MARCH, H-ABC, SCAB-E, CAB etc... they all have nearly identical priority hierarchies, and controlling hemorrhage falls above nearly everything else... in context. On the other hand, once you've fixed the massive bleed, I don't see anything wrong with properly applying a chest seal per SOP and monitoring the patient for signs of respiratory difficulty and tension pneumothorax, and then "burping" the seal as needed, but really, it's contextual to the extent of trying to figure out what will kill the patient first and fastest, and then solving for said problem. It's really hard to mess up a chest seal if you are continuously monitoring your patient's status and understand how the intervention works.

    Even then... I've seen laypeople taught how to properly apply chest seals by my jurisdiction's medical director, and while the signs and symptoms of tension pneumothorax were discussed and taught to them, in the context of where this training is being held (an area where a Level I trauma center is no more than 15 minutes away at any time) he isn't concerned about tension pneumos.

    For reference, my experience is at the prehospital level, so your mileage may vary with the above.
    Last edited by Leftie; 12-09-19 at 10:06.

Page 3 of 3 FirstFirst 123

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
  •