# Would a petrolatum gauze be good for an open chest wound?



## ThatEMTGuy (Mar 19, 2015)

i always thought it was plastic like material taped on 3 sides, but would it work with petrolatum gauze taped 3 sides as well?


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## DesertMedic66 (Mar 19, 2015)

Good luck actually getting the tape to stick on the gauze. What is normally done is to just peel off one side of the foil wrapping and then place the gauze and the other piece of foil over the injury and then tape it down.


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## ThatEMTGuy (Mar 19, 2015)

DesertEMT66 said:


> Good luck actually getting the tape to stick on the gauze. What is normally done is to just peel off one side of the foil wrapping and then place the gauze and the other piece of foil over the injury and then tape it down.


gotcha! tape down on 3 sides as well?


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## LACoGurneyjockey (Mar 19, 2015)

Yes.


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## DesertMedic66 (Mar 19, 2015)

ThatEMTGuy said:


> gotcha! tape down on 3 sides as well?


Some textbooks and protocols say 3 while others say all 4.


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## Jim37F (Mar 19, 2015)

I was taught for the sucking chest wound tape 3 sides, but tape all 4 sides if there's an exit wound on the back


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## Medic496 (Mar 26, 2015)

Taping the occlusive dressing is the ensure that air does not re-enter the chest cavity.  Also, as the patient breaths and the lung fills, the air in the chest cavity will need to escape.  Taping three corners allows the cavity to "burp" out any air that was causing the pneumothorax.   A paramedic could do needle decompression "needle T" of the chest cavity to remove the air causing the pneumothorax or tension pneumothorax. 

Basically, each wound is different and needs to be treated prn.  However, understanding why you are applying tape and what the intent of the dressing or bandaging is for and why is most important.


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## Carlos Danger (Mar 26, 2015)

I would use an occlusive dressing. I can think of no advantage that petroleum gauze would offer.

Given the shape of the thorax, the uneven shape of many wounds, and hair, blood, and sweat on the skin, it could prove pretty difficult to neatly and securely tape down 3 sides yet leave one side open just enough that air can escape yet close enough to the skin that air won't be entrained. Much simpler and quicker to just tape all of it down as secure as possible.

Then _if _a tension pneumothorax results during transport, you can just peel the dressing back a little to allow air to escape, and then re-secure it.


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## Angel (Mar 26, 2015)

Okay something I never understood was, why poke them again if they already have a hole?


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## MonkeyArrow (Mar 26, 2015)

You poke them again because the other hole is now covered up with an occlusive dressing that you have applied and there is now no way for air to escape. The air in a tension pneumo is trapped between the lung and the chest wall. Therefore, the only way for the air to be relieved is to take it out through the chest wall. I understand what you are saying about why make another hole when the first one caused the problem, but the cannula will not allow as much air in as it does out. Air likes to take the path of least resistance. It is much easier for it go into your lungs/pleural cavity by mouth/breathing rather than through a tiny tube. Try breathing in through a straw and then out again. See which one is easier, and how much air you are able to inhale each time.


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## DesertMedic66 (Mar 26, 2015)

MonkeyArrow said:


> You poke them again because the other hole is now covered up with an occlusive dressing that you have applied and there is now no way for air to escape. The air in a tension pneumo is trapped between the lung and the chest wall. Therefore, the only way for the air to be relieved is to take it out through the chest wall. I understand what you are saying about why make another hole when the first one caused the problem, but the cannula will not allow as much air in as it does out. Air likes to take the path of least resistance. It is much easier for it go into your lungs/pleural cavity by mouth/breathing rather than through a tiny tube. Try breathing in through a straw and then out again. See which one is easier, and how much air you are able to inhale each time.


Why not just "burp" the occulsive dressing?


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## Carlos Danger (Mar 26, 2015)

DesertEMT66 said:


> Why not just "burp" the occulsive dressing?



Because then you don't get to stick a needle in their chest.


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## COmedic17 (Mar 26, 2015)

Occlusive dressing.

The foil wrapper or package that was used to package the petroleum dressing would work better as an occlusive dressing then the petroleum dressing itself. Good luck getting tape to stick on a petroleum dressing. 


When I secure an occlusive dressing I tape all 4 sides - except on two sides  I only tape about 3/4ths as to leave one corner "un-taped" . I find it easier to "burp" and it doesn't "leak" as much as only taping 3 sides and leaving an entire side un secured. But that's just a personal preference. 

Also if your just walking up on someone with an open neck wound, chest found, etc slapping your gloved hand over it works well as a temporary occlusive dressing until you are able to properly apply one.


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## COmedic17 (Mar 26, 2015)

Also if the patient is not breathing on their own ( dead, RSI'd, or is being ventilated soley via bvm, tube, etc) there is no negative pressure being created from the diaphragm contracting. So although important to slap on an occlusive dressing,but a stop cock/flutter valve on after a needle decompression, - there's less concern of a sucking chest wound or air being pulled in after a needle decompression due to the diaphragm not causing that difference in pressure. So do what you need first ( airway, take care of major bleeds, etc)


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## cruiseforever (Mar 26, 2015)

We use defib. pads to seal a chest wound.  If we suspect a tension pneumothorax we will needle the chest.


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## Angel (Mar 26, 2015)

Defib pads are so expensive!


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## patzyboi (Mar 28, 2015)

My FTO told me that the petrolatum gauze is the occlusive dressing, except you do need to tape 3 sides.
I've never used one, so I dont know how well it sticks.

What I was taught in school was to tape 3 sides for an open chest wound, if it doesnt work, change the placement of the tapes.
If that doesn't help, then remove the dressing altogether in order to remain the current situation.

I've never had any special instructions in treating an open would with an exit wound in the back. Any insights?


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## cfd3091 (Mar 28, 2015)

This site has very good training resources. My former Dept. uses them for our Tac and Active Shooter bags. Anything will work even a package wrapper if that is all you have. The defib pads stick to anything and Ashermann's won't stick to anything. I've heard of Medics using Breachers Tape with some petroleum jelly around the hole. I've never done that but it makes sense it would work.


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## OnceAnEMT (Mar 28, 2015)

Angel said:


> Defib pads are so expensive!



Not expired ones!


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## Carlos Danger (Mar 28, 2015)

Angel said:


> Defib pads are so expensive!



Yeah but how often do you have to seal a chest wound? I think it sounds like a good idea.


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## Handsome Robb (Mar 28, 2015)

I've never been able to get a patient with a open chest wound and pneumothorax to actually vent through their wound. That's why I poke them. 

Also Defib pads work great, especially on through and throughs.


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## STXmedic (Mar 28, 2015)

The petroleum gauze is worthless. I've had to use it twice, neither times could I get the tape to stick well enough to form a three-sided occlusive. I ended up just putting three long strips of tape over it to secure the entire thing down. Now I just use hyfins and dart if I have to. I've used the hyfins countless times with zero issues.


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## Kevinf (Mar 28, 2015)

Did you remove the gauze completely from the packaging or use the foil wrapper as a backing?


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## STXmedic (Mar 28, 2015)

Both. On one of the two I opened it, placed the gauze portion against the wound with the foil as backing; the other time I didn't even bother opening it.


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