A Consideration for Austere Management of Sucking Chest WoundsToday we are going over one of the leading preventable causes of death on the battlefield: Tension Pneumothorax. Don't get hung up on the medical words, we'll have you understanding how to and why you treat a gunshot wound from Neck to Naval in no time. The battlefield sets the example for first line care because we learn from our mistakes and translate them into the civilian care. The front line medics are expected to uphold the standard in Austere Medicine where they don't have an ambulance but just the supplies on their back. However, not just the Combat Medics on the battlefield are trained, but non-medical professionals are being taught how and why to save lives in first aid. This is where the Austere Medical provider comes in, when 911 is not coming and you have to treat and get them to the next level of care by yourself or with the assistance of your Emergency Action Group. Before we can go over how to treat, we must understand "why" we are treating:
"What is a pneumothorax?"As the picture above demonstrates, you have a wound from you neck to your naval, letting air go out of the hole(s) instead of out of your mouth, which is not good. You won't get quality oxygen where you need it and pressure may build up putting pressure on the lungs and heart until failure.
"Why should I be worried about a pneumothorax?"From hunting accidents, negligent discharges on the range, to active shooter and self-defense situations, we may get injured ourselves and that is just including gun shot wounds. In addition, if Tension Pneumothorax is the second most preventable cause of death in the battlefield where we wear body armor, it's even more likely in an austere situation where we likely don't have body armor. Some medics do not see chest wounds progress from open to tension pneumothorax due to it taking awhile to build up but we have short evacuation times in Iraq/Afghanistan. When it often takes less time to get a bird overseas than it does to get a bird or ambulance in the states, this is another reason to consider this injury a priority where 911 is not coming and this injury has more time to manifest.
" So how do I treat it? I see Vented and Non-Vented Chest Seals." [caption width="300" id="attachment_1484" align="aligncenter"] Taping three sides and leaving a corner to vent is an outdated method.[/caption] If you look around you'll see many variations of the chest seal over the last decade. Occlusive Dressings, Taping on three sides, burp valves and other vents. I'm here to make sure you have an educated decision. This is not a guessing game on what might work, these chest seals are all rigorously tested both on and off the battlefield from U.S. Army Institute of Surgical Research (USAISR) to Committee on Tactical Combat Casualty Care (CoTCCC). They came out with some new updates, which is important because just because you take a medical class in 2006 does not mean you are "set" and never have to take one again. Doctors take continual classes every year to stay on top of what is current, so when it comes to First Line Care, you should have the same mentality that what is best changes. An emergency is not the time to attempt outdated care or try to save a few bucks by getting a knock off or older chest seal. Using what you have available as a contingency and preparing ahead of time are two different aspects; you know if it was you that was wounded, you would want a superior product: [caption width="300" id="attachment_1483" align="alignleft"] Hyfin Vent Chest Seal in Use[/caption] We have been using occlusive (non-vented) dressings which would trap in the air and increase pressure in the chest cavity AKA Tension Pneumothorax translated simply to "Pressure from Air in Thoracic Cavity." By using a fully occlusive dressing you could take a bad situation like an open pneumothorax and make it into a more lethal Tension Pneumothorax. Instead of letting air escape out of the wounds hole, you are now trapping the air inside, inflating the lungs cavity much like a tire. With a vent you let out enough air to avoid the tension while still assisting proper ventilation through the windpipe. The CoTCCC guidelines quote, " All open and/or sucking chest wounds should be treated by immediately applying a vented chest seal to cover the defect. If a vented chest seal is not available, use a non-vented chest seal. " Hyfin Vent Two-Pack Instead. If you're dressing has a "burp" such as an Asherman or Bolin, I'd recommend switching to the more reliable Hyfin Vent as well due to the three-vents offering more redundancy when it comes to getting clogged up by debris or blood. If two of the vents are completely occluded, the third can still function enough to work. Final Tips: No matter which chest seal you use, Petrolatum Gauze ($3.99) , HALO XL, Hyfins, or any other method, I have a bit of advice:
- Prepare your site! Use your sleeves, gauze or clothing to dry the sweat or blood from where you are about to place it. If the patient is hairy, you definitely need to dry it because the hair can make it even more difficult to get on and stay on. Don't throw it on there in the heat of the moment and cause your intervention to fail. Take deep breath, take a second and properly dry your site with whatever you have available.
- When you find the sucking chest wound during your Trauma Patient Assessment (Click here to see how) , you can use the back of your hand, not palm to cover the wound with your gloved hand. This frees up your fingers to help open the packaging while you prepare your supplies while having the added benefit of making it less likely bear weight on that arm and 'push down' on your patients wound if you have to reach or lean across them.
- You've run out of chest seals, had a mass casualty, or your original came off during transport. What now? Use the package it came in as an improvised occlusive dressing and tape it down.
- As always, the equipment is only as good as the training. You can use tape and the packaging to practice covering a chest seal for the low-cost of tape. "Dry Firing" isn't only for Combat Marksmanship , It's for Medicine, too!