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Author Topic: Chest seals  (Read 1176 times)

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Offline Flight-ER-Doc

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Chest seals
« on: March 31, 2011, 09:03:11 PM »
Chest seals are handy things to have for penetrating chest injuries...which causes the lung inside the chest cavity to collapse, resulting in no air exchange.  Penetrating chest injuries (sometimes called sucking chest wounds) can happen from almost anything, a gunshot wound, a stabbing, industrial accidents and shrapnel from any sort of explosion.

Treatment is simple:  Cover the holes in the chest with an occlusive (airtight) dressing, and secure it to the skin.  Check for entry and exit wounds, front and back. 

There are purpose-made devices for this, the Asherman chest seal, the Halo seal, the Bolin....http://www.chinookmed.com/cgi-bin/category/s-thoracic_airway


Prior to these devices being invented (in the last 20 years or less) the treatment was to use vaseline impregnated gauze (petrolateum gauze, etc).  Conventional wisdom was to peel open the foil pouch and use it, throwing away the gauze.... then tape it down well.  Various schemes exist advocating taping three corners, leaving a 'valve' for escaping air...just be prepared to remove anything you put on a patient, if the patients condition suddenly deteriorates faster.

But what if you don't have a purpose-built chest seal, or even petrolateum gauze?

Any sort of airtight material will do.  Aluminum foil, saran wrap, a plastic bag.

You could even use the plastic, adhesive pouches that FEDEX and UPS provide (free) to put the shipping documents in for your packages....they stick (as well as most), they're big enough, and they may be available.

Something to think about.
Yes, I'm a physician.  No, I'm not YOUR physician.  Nothing I say here is medical advice.

Do I treat Glocks like I treat my lawn mowers?  No, I treat them worse.  I treat my defensive weapons like my fire extinguishers and smoke detector - annual maintenance and I expect them to work when needed

Offline AuricTech

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Re: Chest seals
« Reply #1 on: March 31, 2011, 10:15:31 PM »
Lo, these many years ago (1984), when I had first aid training in US Army Basic Combat Training, they told us that the best time to apply an improvised chest seal (they suggested using the plastic wrapping the casualty's first aid dressing came in) was after the casualty had exhaled, as this would provide a better seal.

Is this still considered "best practice"?
American parachutists...devils in baggy pants...are less than 100 meters from my outpost line. I can't sleep at night; they pop up from nowhere and we never know when or how they will strike next. Seems like the black-hearted devils are everywhere....


Offline Flight-ER-Doc

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Re: Chest seals
« Reply #2 on: March 31, 2011, 10:41:40 PM »
Lo, these many years ago (1984), when I had first aid training in US Army Basic Combat Training, they told us that the best time to apply an improvised chest seal (they suggested using the plastic wrapping the casualty's first aid dressing came in) was after the casualty had exhaled, as this would provide a better seal.

Is this still considered "best practice"?

Yes, if you can.  Plugging the hole is important though, don't try and redo a bandage if it's not right.
Yes, I'm a physician.  No, I'm not YOUR physician.  Nothing I say here is medical advice.

Do I treat Glocks like I treat my lawn mowers?  No, I treat them worse.  I treat my defensive weapons like my fire extinguishers and smoke detector - annual maintenance and I expect them to work when needed

Offline Drang

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Re: Chest seals
« Reply #3 on: April 01, 2011, 01:38:09 PM »
What was that thing Loony Clooney used in "Three Kings"?
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Offline Flight-ER-Doc

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Re: Chest seals
« Reply #4 on: April 01, 2011, 03:03:17 PM »
I never saw that piece of propaganda (aside from a trailer) so I don't know.  Don't get your medical education from Hollywood, though. 
Yes, I'm a physician.  No, I'm not YOUR physician.  Nothing I say here is medical advice.

Do I treat Glocks like I treat my lawn mowers?  No, I treat them worse.  I treat my defensive weapons like my fire extinguishers and smoke detector - annual maintenance and I expect them to work when needed

Offline Dale00

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Re: Chest seals
« Reply #5 on: April 01, 2011, 05:26:22 PM »
Dumb question: Is a sucking chest wound obvious? Is there always a noticeable sound?
"Test everything. Hold onto the good." 1 Thes 5:21

Offline Flight-ER-Doc

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Re: Chest seals
« Reply #6 on: April 01, 2011, 07:43:39 PM »
Dumb question: Is a sucking chest wound obvious? Is there always a noticeable sound?


Not a dumb question at all, and NO, they are not obvious.  It's one reason civilian medics are taught to 'strip and flip' patients, to look for them.  There was a case about 15 years ago of a woman who died in Los Angeles, she had been shot and nobody noticed (even in the ED) due to her 'pendulous breasts' - apparently she was a large woman.

Things to look for are a sudden shortness of breath, cyanosis (blue coloration of face, lips,  mucous membranes), decreased lung sounds on the affected side of course, and possibly if the collapsed lung causes it, muffled heart sounds and trachial deviation (the line of the trachea, windpipe, should be pretty much midline - if if deviates to one side or another it's usually not normal).

But mainly, if someone is shot in the chest, plug the hole.  It won't hurt the patient any worse (usually - if it does unplug the hole).  And don't forget to look for more than one hole.

Yes, I'm a physician.  No, I'm not YOUR physician.  Nothing I say here is medical advice.

Do I treat Glocks like I treat my lawn mowers?  No, I treat them worse.  I treat my defensive weapons like my fire extinguishers and smoke detector - annual maintenance and I expect them to work when needed


 


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