Treatment for flail chest

[Topher38]

Bulky dressing thats what I learned, Just got certified a few months ago.

 

[Jeremy89]

Bulky dressing thats what I learned, Just got certified a few months ago.

Haha, I can't remember half of what I learned and that was just in January... but regarding the flail chest, that's what I recall- using a bulky dressing.

 

[ERnurse17]

r u talking about a open sucking chest wound. cause i dont think that flail chests have to be open they can be closed. maybe i misunderstood you.

 

[ERnurse17]

Flail Chest.

1. Have pt. take deep breath in, place bulky dressing in hole.
2. Have pt breathe out while you are holding bulky dressing, and at end of exhalation (sp?) tape in place.

Are u talking about a sucking chest wound cause i dont think that flail chests have to be open. Im sure they could be but the treatment you are talking about is for sucking chest wounds. Maybe i misunderstood your post.

 

[CFRBryan347768]

Haha, I can't remember half of what I learned and that was just in January... but regarding the flail chest, that's what I recall- using a bulky dressing.

That is very reassuring, thank god your more than 8+ states away LOL:blush:

 

[Ridryder911]

Okay, maybe before treating or attempting to treat, one should review what flail segments are and what it can produce. There is quite of bit of difference between a flail chest wall and a sucking chest wound.

Truthfully, I rarely splint or even attempt to splint flail segments. Really, is a padded bulky dressing going to do any good. Might as well give them a pillow and tell them to hold against their chest wall, as someone mentioned earlier the key point is the potential injuries related to the flail segment and the paradoxical movement you will see. Of course a pnuemothorax, but pulmonary contusions and lacerated vessels, in which the detection is the key, and very little treatment is performed at a BLS level.

Consistent review is essential, if one is not currently working or have a working knowledge.

R/r 911

 

[mikeylikesit]

if they already have a pneumothorax though they are screwed unless you can alieviate tension. bulking it down will only apply more pressure and less relief in this situation. so before you place the dressing look for other signs.

 

[REMSI Medic 10]

Just a quick question for everyone (I am also going to do my own research to see what I can find out on my own).

What is currently being taught to EMTs regarding the management of a flail chest?

I ask because we held a physical agility and practical testing today as part of the hiring process. For the trauma scenario the patient had a flail chest and an open tib/fib fracture. Of the nine canidates that we had, only three of them even acknowledged the fact that the patient had a flail chest. Of those three only one used a bulky dressing against the flail segment. A second put the bulky dressing on the opposite side of the chest as the flail segment, and the third person said they could use a bulky dressing but that BTLS is teaching to no longer do that. (Could anyone out there verify if this is true?)

We were just surprised that the other six didn't even acknowledge the injury and were trying to figure out why that may be. Thanks for any input you guys may have!

we were taught to use bulky dressings to hold down a flailed segement.

 

[REMSI Medic 10]

if they already have a pneumothorax though they are screwed unless you can alieviate tension. bulking it down will only apply more pressure and less relief in this situation. so before you place the dressing look for other signs.

but there isn't anything a EMT-B can do for a pneumothorax(or any kind of thorax) in the field without a ALS provider there to help.

Well, other than 15L non-rebreather and some diesel therapy and wait for ALS to get there.

 

[mikeylikesit]

but there isn't anything a EMT-B can do for a pneumothorax(or any kind of thorax) in the field without a ALS provider there to help.

Well, other than 15L non-rebreather and some diesel therapy and wait for ALS to get there.

yeah, but you could...not make it worse, do what your trained to do though, cause unless you can make that distinction, it wouldn't be a bad thing to bulk it down to help provide comfprt to your patient.

 

[philfry]

Our protocol here is if the patient is conscious, splint obvious flail segments with bulky dressing. If unconscious move straight to intubation and airway protocols. However, I have yet to see anyone splint any segments...

 

[DBieniek]

Were some of you guys not required to become a PHTLS (or equivalent) provider prior to obtaining your EMT-B liscense?

 

[Epi-do]

Here, PHTLS, or any other trauma cert is not required to be an EMT in IN.

 

[DBieniek]

Oops, I phrased that wrong. It's our company that requires PHTLS, BTLS, etc before being hired. It has nothing to do with getting your card.

 

[alex71]

i jsut finished my class a few days ago and we were taught the whole time direct pressure and bulky dressings 07/09/08

 

[traumateam1]

Does anyone use/stock or learn how to use the Asherman chest seal? Essentially its a big sticker with a one-way-valve on it. We used them a lot in Israel, and i know they are manufactured here, but I havent seen one.

OH! OH! I have one!! But... haven't used it yet... :sad:

 

[traumateam1]

Getting back to the treatment of a flail chest. Here in BC you are suppose to tape a bulky dressing onto the injured side. That's what it says in the text book. Oh and the obvious watch for resp. destress and then failure.

 

[NC-EMT08]

I just finished Basic class the beginning of this month with the AAOS book, "Emergency Care and Transport.." We were taught to stabilize flail segments with a bulky dressing during the rapid trauma assesment after checking for JVD, tracheal deviation, etc.

 

[mycrofft]

Res Tech, I'm with you plus some other potshots.

Welcome to the interface between real world and protocols. Use your local protocol, but Res Tech seems to me to have the best handle. Figure out how to get local protocols to reflect the real world if they don't already.

If I hear the words "pulse ox" again today I'm gonna squeal. (Sorry, been a long day at work). Flail chest is established clinically, and part of the pretty early presentation is lessening oxygenation. Put on the O2 however you need to and within protocols, but spend not your time on little flashie thingees until the pt is supported. If the O2 sats continue to drop, what are you going to do differently, besides drive faster and maybe attempt to address a hemo/pneuomthorax which also is evident clinically?

I think the true questions about flail chest revolve around delay and transport: how can you get Vickie Victim or Pete Patient out of the woods after extrication? Any input from the active duty military members? Any ER docs or techs or nurses? Wilderness med folk?

 

[gradygirl]

In both my Basic and Intermediate classes, we were told to split the fracture site with bulky dressings. After doing some research in medical journals, I have found a common conclusion: while splinting is not necessarily harmful, it is harmful to splint with something heavy or restrictive, such as a sandbag or belt. Sandbags, and the like, are too heavy to allow for adequate chest rise, potentially leading to hypoventilation, etc. Other types of splints do in fact do give some comfort to the patient.

So, it looks like everyone is right. Yes, splinting is ok. No, splinting with overly restrictive devices in not ok. To put a blanket statement that "all splinting is ok" or "all splinting is harmful" is not painting the entire picture..

However, always follow protocols, because as we know, you gotta CYA.