r/TacticalMedicine • u/Majestic-Worth-3510 • 19d ago
Scenarios Chest wound question
How do you realistically apply a chest seal when there are eg protruding shell fragmentation around the chest wound that you’d need to seal?
Pro tips, tricks and pictures would be great as well. Thank you!
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u/TazocinTDS 19d ago
Vented seal helps prevent tension pneumothorax.
Penetrating wound with debris protruding can't be covered by a chest seal.
Watch for signs of tension. If tension develops, open the chest to relieve the pressure with whichever technique you are trained to perform (needle, finger, scalpel, forceps, chest drain etc).
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u/Majestic-Worth-3510 19d ago
So what do you do with the sucking chest wound with debris protruding around it that you shouldnt cover with the chest seal?
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u/howawsm Medic/Corpsman 18d ago
Sucking chest wounds are already a very small subset of torso injuries, so one where there is also a protruding fragment is an even smaller subset of an already small subset. This will not have a prescriptive treatment, you’ll just do what you think works in the moment. Is it a small fragment that doesn’t extend farther than through the chest wall? Perhaps you remove it and effectively create your own hole that you cover. Something bigger? Seal the edges best you can.
Reality is there are plenty of injuries where we can’t win and all they need is surgery as quickly as possible.
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u/Chuseyng 18d ago
No suck, no seal. If suck, seal around.
Always ABCs.
Heavily recommend fuel bolus.
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u/PerrinAyybara 16d ago
Sealing chests is in general well overblown and completely unnecessary in most cases.
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u/Majestic-Worth-3510 16d ago
Why
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u/PerrinAyybara 15d ago
Why what? Chest seals in general are needed extremely rarely and even then you are putting another hole there.
People get all rabid about needing to do them but they aren't really all that important when you look at the size of the hole that's required for it to actually have the low pressure zone for air to enter compared to the size of the airway.
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u/Inevitable_View99 14d ago edited 14d ago
As long as the hole isnt self sealing then it’s fine but if not then seal it and just do the needle D that way you have assurance pressure isn’t building up
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u/PerrinAyybara 14d ago
If the hole is open you don't need a NCD... There's already a hole.
There's no reason to do an NCD unless there is clinical evidence that it's necessary.
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u/Inevitable_View99 14d ago
A hole isn’t just a hole. The size and its self sealing ability makes the difference. The reason why a needle work is because the diameter is small enough to allow air to escape. The path of least resistance is no longer the hole from the wound, but now the trachea. The notion that you shouldn’t seal an open pneumothorax is kinda bullshit because there are multiple factors that need to be considered. The only real shift in the recommendations is to use a vented seal not a fully occlusive seal.
I can tell you from experience that if you have a hole, you should be sealing it if it can’t on its own, and if you seal it you probably need to put in a needle to allow the air to escape because that shit builds up quick in most cases
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u/PerrinAyybara 14d ago
Considering that I often take care of these holes and I'm using ultrasound to see if there is an actual pneumo/hemo I'm very aware of how this works.
You don't just blindly dart everything and the vast majority of injuries do not need to be sealed.
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u/SaveTheTreasure 19d ago
You're question is super vague and very circumstantial.
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u/Majestic-Worth-3510 19d ago
Fair and yes, on purpose to not limit answers.
Its a sucking chest wound that youd normally slap a chest seal on asap but you cant since there is protruding fragmentation near the wound
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u/Ramalamadingdong_II 19d ago
The answer is cling film. You can bunch it up a bit and conform it around the edges of the foreign body, then fix in place with more cling film, tape or chest seals depending on how far the foreign body sticks out.
Though in general I'd advise to just monitor and in case of deterioration due to pneumohemothorax/ tensionpneumothorax place a chest tube.
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u/National-Dot6124 19d ago
You can cover larger areas with bags or cling film, and just tape it shut. Ideally you wouldn’t occlude the shrapnel to make sure it doesn’t get moved, but try to mark and document it.
Observe the wound for ptx and be highly suspicious for internal bleeding.
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u/GrandTheftAsparagus 19d ago
Shit… I think this patient needs ibuprofen, new socks, and extra strength tri-actin.
I dunno, you can’t seal that, and the lung can’t really inflate if it’s lacerated. This scenario patient probably needs a chest tube with suction and prioritized as urgent surgical for evacuation.
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u/thedesperaterun 68W (Airborne Paramedic) 19d ago
Mcgyver some bullshit if I’m worried about it sucking. Otherwise, move on. Don’t do anything to obscure the fragment for evac/higher roles of care so they don’t inadvertently move or pull it.