# Sucking Chest Wound. Occlusive Dressing or 4x4 Gauze?



## Dutchieee (Sep 15, 2015)

In a lot of my studies i found that i was taught to put a 4x4 gauze pad on a sucking chest wound (with tape on 3 sides of it.) but in most of my practice exams. It says if i were to come across a sucking chest wound (or even a laceration to the neck), that i should put an Occlusive dressing over it? (JB Learning being the main one..)

Granted, i know what that is but do we as EMT's actually carry that? Or maybe i just don't remember? I know Paramedics would have to use it to hold IV's in place but other than that i've never seen or heard that in practice?
Would anyone care to elaborate for me?


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## RedAirplane (Sep 15, 2015)

The best would be a chest seal because it's rapid and has a one-way valve.

Otherwise, an occlusive dressing with tape on 3/4 sides is typically what I was taught.

In a pinch, you could use a glove or cling wrap as an occlusive dressing. Also the wrappers that all your other stuff comes in.


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## Flying (Sep 15, 2015)

There really shouldn't be any barriers to having occlusive dressings on a BLS ambulance. They're generally recognized as being a good dressing for open wounds. My state requires a number of occlusive dressings on every licensed BLS ambulance.

As for the actual care of open/sucking chest wounds, a dressing with a valve/vent is the way to go.

If you're stuck with the choice of a three-sided gauze pad or an occlusive dressing, there has been a recent shift in how to go about it.
https://www.jsomonline.org/SharedScience/2013381Butler.pdf
We figured that the three-sided dressing doesn't make much of a difference. Now the current recommendation made by physicians is to cover with an occlusive dressing (or non-vented chest seal), monitor for signs of tension pneumothorax, and relieve pressure as needed.

Ask your instructors and figure out on your own what you are supposed to know for the exam. It may or may not reflect reality.


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## EBMEMT (Sep 15, 2015)

If you were taught to put a 4x4 gauze pad on it, you are missing a crucial detail such as that you use PETROLEUM (jelly) gauze or to leave the (rare) plastic or foil wrapper on the gauze pad.   Of course, you can't really tape to petroleum gauze so people use just the aluminized plastic wrapper or leave one side of the wrapper covering the pad and tape to the wrapper (do not do this with regular gauze pad and wrapper).

Regular gauze with tape on 3 sides of it makes no sense.   Gauze is porus so you can't make a one way flapper (flutter) valve with it, which is the reason for taping three sides (or taping four sides but leaving one corner untaped. It is also the reason for using an occlusive dressing.   Which can be tegaderm, cling wrap, aluminum foil (may not be flexible enough for flapper valve), aluminized mylar, glove, zip lock bag, or the plastic wrapper for other medical supplies (clean side towards patient).   

Note that tyvek™  wrappers used to package and sterilize many medical devices are somewhat breathable and might not be sufficiently occlusive; they have small pores that keep water and germs out but allow water vapor to penetrate; this is a medical grade version of the same tyvek (spun bonded polyolefin) non-woven synthetic textile you see used in house wrap (construction vapor barrier), disposable coveralls, better floppy disk sleeves, and better quality mailing envelopes (the ones you can't tear), bibs for bike racers, and certain other waterproof "paper" applications.

If you have a sucking chest wound, you need to let air out but not back in again, to minimize pneumothorax.  

Not surprisingly, the 3 side tape improvised flapper valve has rather dubious effectiveless, like many things we were taught in school.

An article in JEMS recommends use of an Asherman Chest Seal or a defibrilator pad (manually burped occasionally) instead of the usual flapper valve due to the slowness of application and tendancy for adhesive failure in the regular flapper valve.  
http://www.jems.com/articles/print/.../treating-sucking-chest-wounds-and-other.html


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## Brandon O (Sep 15, 2015)

Hmm. Why would they go out of their way to package devices in medical Gore-Tex?


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## Flying (Sep 15, 2015)

Brandon O said:


> Hmm. Why would they go out of their way to package devices in medical Gore-Tex?


http://www.dupont.com/products-and-.../articles/tyvek-medical-packaging-design.html

To create a product such as medical grade X, it would be cheaper to compartmentalize the sterilization process (gas or zap the product) rather than create a specialized facility fitting certain cleanliness standards. Tyvek packaging would enable or expedite the process.

Dry cleaning is cool.


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## MicahW (Sep 19, 2015)

I was always taught the to make an occlusive dressing, you take the packaging from gauze or say an IV extension kit (because the packaging is clear).  The inside will be sterile so use that side on the patient.


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## Jim37F (Sep 20, 2015)

We carry the petroleum gauze specifically to be our occlusive dressings. I was taught tape 3 sides on the chest, tape all 4 sides for neck and exit wounds on the back.


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## NomadicMedic (Sep 20, 2015)

Jim37F said:


> We carry the petroleum gauze specifically to be our occlusive dressings. I was taught tape 3 sides on the chest, tape all 4 sides for neck and exit wounds on the back.



Try and tape that stuff down. Doesn't work.


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## SeeNoMore (Sep 20, 2015)

Yeah I remember ending up with a fistful of gauze , tape and blood. I'm spoiled  now with a commercial occlusive dressing now that's easy to burp.


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## chaz90 (Sep 20, 2015)

Ashermans are remarkably adhesive. Even on slippery and bloody skin I've had great luck with them holding in place.


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## DesertMedic66 (Sep 20, 2015)

I wish we carried the Ashermans. We have nothing that states what we are to use to make an occlusive dressing. In our local EMT classes they are taught to use the petroleum gauze (some programs say to leave the foil backing on and use the foil as the place to tape).


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## DPM (Sep 21, 2015)

Asherman is good, but not great. A defib pad (though expensive!) will work really well if you're in a pinch. Anything occlusive works fine though.


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## redundantbassist (Sep 21, 2015)

We carry hyfin vented chest seals. Although I have never had the opportunity to use one, from what I have heard they stick well to wet skin.


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## Tigger (Sep 21, 2015)

We keep expired defib pads with the leads cut off for chest seals.


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## RedAirplane (Sep 23, 2015)

At a recent training I got to try SAM chest seals. Super easy, and an actual valve. 

In reality we have petroleum dressings with tape... the whole three corners thing.


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## Bullets (Sep 24, 2015)

redundantbassist said:


> We carry hyfin vented chest seals. Although I have never had the opportunity to use one, from what I have heard they stick well to wet skin.


I have used them and they are basically a defib pad without the electronics, its that sticky goo


Tigger said:


> We keep expired defib pads with the leads cut off for chest seals.


This, i keep a set in my personal blowout kit, a number of guys on our tac team keep them in their vests. Perfect for entry and exit wounds


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