# Venigard/Tegaderm over GSW



## Anto (Jul 21, 2011)

I see medics do this for GSW's and stabbings to legs, arms, back, etc. Most of the time they stick, but sometimes (profusely bleeding) they won't hold & we go straight to trauma dressing. My question is, combined with pressure over a dressing, would this hold fairly well?

Anyone do the same? Pros/Cons?


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## jwk (Jul 21, 2011)

Anto said:


> I see medics do this for GSW's and stabbings to legs, arms, back, etc. Most of the time they stick, but sometimes (profusely bleeding) they won't hold & we go straight to trauma dressing. My question is, combined with pressure over a dressing, would this hold fairly well?
> 
> Anyone do the same? Pros/Cons?



It's fine if you need an occlusive dressing, but it is not a pressure dressing.


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## AJ Hidell (Jul 21, 2011)

Exactly.  No amount of pressure is going to stop internal haemorrhage.  So, unless there is profuse external bleeding, there's not any need for a pressure dressing.  Also, remember that a "pressure dressing" has potential to restrict the patient's breathing, so don't get crazy with it. 

People have also been using EKG patches and shock pads for chest wounds for decades.  The concept is not new.  But if you put an occlusive dressing on, you had better stay alert for signs of tension pneumo, or you may kill your patient.


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## mycrofft (Jul 21, 2011)

*Anyone else do this?*

The logic escapes me.


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## lightsandsirens5 (Jul 21, 2011)

Uhhh....never even heard of doing that. 

If it is to occlude an open "sucking" wound to the thorax, I would refrain from doing so as it won't relieve pressure. 

If it is to control external bleeding, I can think of better ways to do that.


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## abckidsmom (Jul 21, 2011)

mycrofft said:


> The logic escapes me.



I put a tegaderm over bullet holes, I found that I never could get the EKG electrodes to stick without fumbling.  Nowadays, I probably won't see a shooting more than once every couple of years if I'm lucky, so it's hardly worth being prepared for.

Just wondering?  What logic are you looking for, mycrofft?  The why of the occlusive dressing?  I don't understand the question.


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## abckidsmom (Jul 21, 2011)

lightsandsirens5 said:


> Uhhh....never even heard of doing that.
> 
> If it is to occlude an open "sucking" wound to the thorax, I would refrain from doing so as it won't relieve pressure.
> 
> If it is to control external bleeding, I can think of better ways to do that.



Lots of times, wounds are just wounds and while they are potentially "sucking" they don't look like it at the time.  So covering them with something occlusive until someone can explore the track is a valuable thing.  You just have to remember to burp them if the heart rate or respiratory rate starts to trend up.


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## lightsandsirens5 (Jul 21, 2011)

abckidsmom said:


> Lots of times, wounds are just wounds and while they are potentially "sucking" they don't look like it at the time.  So covering them with something occlusive until someone can explore the track is a valuable thing.  You just have to remember to burp them if the heart rate or respiratory rate starts to trend up.



Fair nuff...

I have just always used gauze and tape.


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## AJ Hidell (Jul 21, 2011)

lightsandsirens5 said:


> Uhhh....never even heard of doing that.
> 
> If it is to occlude an open "sucking" wound to the thorax, I would refrain from doing so as it won't relieve pressure.


Seems to me like you are addressing two different situations with one answer.  Not all sucking chest wounds have "pressure."  That is a tension pneumothorax.  A simple sucking chest wound is indeed treated with a simple occlusive dressing.  No reason a Tegaderm wont work, if it is properly secured.  This is very basic EMT stuff.  Even the Red Cross teaches this.


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## mycrofft (Jul 21, 2011)

*OP says GSW EVERYWERE.*

Sucking arm wound? (Works great on blisters once they are deroofed and sanitized, though).

Sounds hypothetical  or experimental to me. Medical issues aside, forensic stuff at the entrance could be lost when the tegaderm is removed and tossed into the red bin.


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## abckidsmom (Jul 21, 2011)

lightsandsirens5 said:


> Fair nuff...
> 
> I have just always used gauze and tape.



Gauze and tape are not occlusive.  Penetrating wounds high on the abdomen and on the thorax need to be covered with occlusive dressings just in case they communicate with the pleural space.  Any amount of air that makes its way in there adds to the pneumothorax, and increases the possibility of it getting to be a tension pneumo.


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## bigbaldguy (Jul 21, 2011)

This is probably a newb question but isn't there a "store bought" occlusive dressing most ambulances carry? I'm pretty sure my outfit carries them although I've never used or seen one used.


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## AJ Hidell (Jul 21, 2011)

bigbaldguy said:


> This is probably a newb question but isn't there a "store bought" occlusive dressing most ambulances carry? I'm pretty sure my outfit carries them although I've never used or seen one used.


Yes, there is one.  But no, hardly any civilian ambulances have them.  Most just use a Vaseline gauze with the plastic or foil still attached.

Seriously... are occlusive dressings not being taught in B school anymore?  What about the differences between different types of chest wounds?  This is scary.


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## Akulahawk (Jul 22, 2011)

bigbaldguy said:


> This is probably a newb question but isn't there a "store bought" occlusive dressing most ambulances carry? I'm pretty sure my outfit carries them although I've never used or seen one used.


Yes, there is... Look for vaseline-impregnated gauze. That may be what you have on-board. There are other devices that essentially put a one-way valve on an occlusive dressing so that air can escape and none enter. The Asherman Chest Seal is one such device. Also, using stuff that is found on ambulances, you can normally create occlusive dressings that will do the same thing. I know how to use those devices and how to fashion some of them out of on-board supplies... but fortunately, I've never had to apply them to a patient.


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## lightsandsirens5 (Jul 22, 2011)

abckidsmom said:


> Gauze and tape are not occlusive.  Penetrating wounds high on the abdomen and on the thorax need to be covered with occlusive dressings just in case they communicate with the pleural space.  Any amount of air that makes its way in there adds to the pneumothorax, and increases the possibility of it getting to be a tension pneumo.



Ok, if we are talking penetrating thoracic wounds, then yes you are absolutely right.  I was thinking we were talking about something else. Sorry, sleep deprivation strikes again. 

In that case, I do see how a tegaderm or similar dressing would be of good use. I have always used so other form of occlusive dressing be it plastic, Vaseline gauze or a specific use dressing. Are we not supposed to have a three sided or one way dressing on possible penetrating injuries? AJ was saying not all chest wounds are sucking, and that is true. But if we are occluding the wound to prevent air entry into the pleural area, it should be a three side dressing so that any potential buildup of pressure will be automatically relieved, right?

Or am I totally out of line?


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## mycrofft (Jul 22, 2011)

*OP, how big a Tegaderm are talking about?*

I keep seeing the three by five size in my mind.

Kaplan's "The Dressing Station" describes how he was taught how to improvise a needle and glove chest decompressor. (Kids, don't do this at home).


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## Hellsbells (Jul 24, 2011)

> Sounds hypothetical or experimental to me. Medical issues aside, forensic stuff at the entrance could be lost when the tegaderm is removed and tossed into the red bin.



Like what? Can't think of anything particularly important at the entrance wound that wouldn't be cleared away by blood itself seeping out of the wound.


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## Akulahawk (Jul 24, 2011)

mycrofft said:


> Sounds hypothetical  or experimental to me. Medical issues aside, forensic stuff at the entrance could be lost when the tegaderm is removed and tossed into the red bin.


Some forensic evidence may be lost, but that assumes the shooter is close enough for GSR to get deposited near the wound.


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## mycrofft (Jul 25, 2011)

*Wadding, traces of anything intervening between the barrel and entrance.*

But, FORENSICS aside, medically...I don't see it.

PS: forensic sidebar, don't use plastic suction liners to bag suicide's hands, it messes up the GSR results. And angers the medical examiner. WHen they ask, say "Paper, please").


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## dixie_flatline (Jul 25, 2011)

lightsandsirens5 said:


> ... But if we are occluding the wound to prevent air entry into the pleural area, it should be a three side dressing so that any potential buildup of pressure will be automatically relieved, right?
> 
> Or am I totally out of line?



I was taught in Maryland to fully occlude a possible sucking chest wound.  The instructor did point out (and I think the book had it) that many areas use the 3-sided method, but we were told to fully occlude and monitor vitals for possible build-up.  Fully taping it down seems to make it more secure and just makes more sense to me, but we don't carry 'occlusive dressings' of any kind - ours are tegaderm/bandage covers or whatever else is handy and functional.


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## Akulahawk (Jul 25, 2011)

dixie_flatline said:


> I was taught in Maryland to fully occlude a possible sucking chest wound.  The instructor did point out (and I think the book had it) that many areas use the 3-sided method, but we were told to fully occlude and monitor vitals for possible build-up.  Fully taping it down seems to make it more secure and just makes more sense to me, but we don't carry 'occlusive dressings' of any kind - ours are tegaderm/bandage covers or whatever else is handy and functional.


If a tension pneumo is going to occur as a result of occluding the wound, your patient may start exhibiting signs/symptoms of it long before you'll start seeing it reflected in the vitals... and probably long before you see things like trach deviation and the like. If you're not allowed/authorized to do pleural decompression by needle or surgical methods, check with your local EMS agency and see if they'd allow you to open one side of that dressing allow excess pressure to escape... You may not be authorized to do so, but at least you'll know for certain if you can do it or not in the event that a tension pneumo has developed and causing serious signs/symptoms while the patient is under _your_ care. Other providers may be able to utilize needle or surgical methods to decompress a chest. Getting such a patient to one of those providers should be of paramount importance if you can not do it yourself... along with getting the patient to a provider that can provide definitive care as well.


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## MotorCity (Jul 26, 2011)

Why not do a proper 3 sided occlusive dressing to prevent a possible tension pnumo. Why possibly cause extra possible infection with an angiocath through the chest. Let the hospital do a good chest tube.


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## Akulahawk (Jul 26, 2011)

MotorCity said:


> Why not do a proper 3 sided occlusive dressing to prevent a possible tension pnumo. Why possibly cause extra possible infection with an angiocath through the chest. Let the hospital do a good chest tube.


I would be highly inclined to agree with you... To me it just makes sense that if you have a pretty large hole and you've created a one-way valve properly with the 3 sided occlusive dressing, you'll see better results than if you completely occluded the wound and later had to use angiocaths (them big ones:blink in an attempt to relieve the pressure that's built up...

And if you can't do a thoracostomy tube yourself... if the patient needs one, get the patient to someone that can!


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## MedicBender (Aug 5, 2011)

dixie_flatline said:


> I was taught in Maryland to fully occlude a possible sucking chest wound.  The instructor did point out (and I think the book had it) that many areas use the 3-sided method, but we were told to fully occlude and monitor vitals for possible build-up.  Fully taping it down seems to make it more secure and just makes more sense to me, but we don't carry 'occlusive dressings' of any kind - ours are tegaderm/bandage covers or whatever else is handy and functional.



I thought current MIEMSS ambulance standards required some sort of occlusive dressing on BLS units?


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