Venigard/Tegaderm over GSW

[anto]

Our medics do this for GSW's and stabbings to legs, arms, back, etc. Most of the time they stick, but sometimes (profusely bleeding) they won't hold & we go straight to trauma dressing. My question is, combined with pressure over a dressing, would this hold fairly well? It seems like a good option to keep stuff out.


Anyone do the same? Pros/Cons?

[chuckman]

I have not seen it done. I can see, though, with small, seeping wounds where a folded 4x4 and a tegiderm may be sufficient, but I am not really seeing the purpose. It wouldn't be my first go-to.

[lethal dose]

Personally, I'd rather worry about simply stopping the blood loss long enough to reach the e.r. and let the hospital fuss with dressing the wound. This, of course, is my opinion only and is not to be considered/used as advice.

[Gutshot John]

I've seen chest seals used for this purpose but I doubt tegaderm would be a functional choice for reasons of adhesion.

[ST911]

Can work as an expedient, depending on size, shape, and output of the wound. Tegaderm, chest seals, or a tape mat functional on the same theory in that usage.

[zekus480]

My PA and I are discussing this right now, and we don't see the benefit of using an occlusive dressing on penetrating trauma. A principle of TC3 (Tactical Combat Casualty Care) is to stop life threatening bleeding by placing a tourniquet as high and tight as possible for extremity bleeding, combat gauze with ace wrap or an Israeli can be used after re-evaluating the need for a tq. For thoracic trauma with pnuemothorax, I can see where you could use a large tegaderm but there are better alternatives for Tactical Field Care like the HALO seal, HYFIN, or MRE packaging with some gorilla tape. I'm not trying to sharpshoot these medics, I would like to know because if there's a lot of positives of using TD we could do the same where I’m at.

[Limey-]

Tegaderm is pretty useless in wet environments. Profuse bleeding requires a pressure dressing and heavy wide 3M Microfoam based tape or similar, tegaderm will not function and was not designed for any kind of moderate to large chest wound. There are much better choices out there. Saran wrap works better in a pinch on a chest wound, most of the chest seals are pretty weak without duct tape. Get the chest needled, get a chest tube in, stop the bleeding get volume in and get em to a surgeon quickly. Done way too many GSWs and penetrating trauma's in my time.

[Gutshot John]

Most of the chest seals are pretty weak without duct tape.

That's not been my experience, usually chest seals stick to everything, sometimes it's annoying, what seals are you using?

Get the chest needled, get a chest tube in, stop the bleeding get volume in and get em to a surgeon quickly. Done way too many GSWs and penetrating trauma's in my time.

He's not really talking about a chest injury per se, he's talking about using a chest seal on standard GSWs. So say a small entrance wound that can be done with an expedient like a chest seal and a pressure dressing on the large, profusely bleeding exit wound.

That said your protocols have you putting in chest tubes? You've got the gear/time to do that? Interesting, can I ask where you run?

We typically grab and go on trauma and don't even mess with anything more than a Decompression. Typical transport time is usually 10-20 minutes from the time we roll from the scene, generally we're not on the scene for more than 10 mins.

It's worth remember guys that while TQs are the preferred solution for rapid hemorrhage control, it is only pervasive in the military, not every local service allows this to occur...yet.

[MIKE G]

Why? what is the advantage? To make your patient look good for the ED? I would focus on a follow up assessment, extra set of vitals for trending, etc.

Most trauma patients are going to get either PO or IV antibiotics post GSW so trying to keep 'stuff' out would really only apply in some of the nastiest environments and a 5x9 and some wrap or duct tape is going to be more secure. I also don't like the idea of 'disguising' wounds as it lends to something potentially being missed after handoff.

If it is from the waist to the chin put a chest seal on, if it is anywhere else it can be packed and/or wrapped.

[chuckman]

Also remember that everything that goes on or in a patient comes off or out, usually pretty soon after getting to an ED. If the holes aren't really bleeding sometimes all you need is a 4x4 and some tape. There aren't style points in this business.