Occlusive Dressings

[guamie]

I have a question that I am sure that I am way over thinking...
I know that for an open/sucking neck or chest wound you apply an occlusive dressing, right? If the pt is bleeding, you obviously want to control the bleeding first. If there are dressings applied to control the bleeding, do you put the occlusive dressing right over the original dressings and tape on 3 sides? I was taught to never take off any dressings used to control heavy bleeding, if needed, apply more dressings. If you put the occlusive dressing on top of blood soaked dressings, does the occlusive dressing still work properly? I just don't want to look incompetent should this occasion occur. Thanks...

 

[Meursault]

As I understand it (have yet to actually use an occlusive dressing in the field), the important point is to get a seal. If you're doing a full occlusive dressing for a neck wound or possibly an evisceration, you can go right over a couple layers of gauze and just tape it on, because you still have an air-tight seal. The gauze has just been sealed into the dressing. If the size or bulk of the dressing under the seal is an issue, get out the Saran Wrap. For an evisceration, that's precisely what you do, albeit with moist gauze.

For a sucking chest wound, the extra layer might lift the corner that should be a flutter valve off of the chest. Accordingly, you might be better off placing the occlusive dressing, accepting that you can't control internal bleeding with an external dressing, and just applying pressure if needed and letting any blood leak.

Caveats:
1. Your protocols and medical director have the final say.
2. Sucking chest wounds shouldn't be bleeding all that much anyway, as I understand them.
3. I don't think that you're going to encounter many, and if you do, looking like an idiot should be very low on your list of priorities.

 

[Ridryder911]

I don't know who is teaching not to remove dressings, but unless there is a large amount of bleeding, that is the first thing I do. Can't see it, cant document it. Too many providers is so worried about simple lacerations or wounds that has little bleeding, especially venous type. I guess since there is nothing else to do other than worry about bandaging. In the real world, a simple coverage will do.

In regards to SCW most chest wounds bleed very little externally. Sealing the wound is more a priority than worrying about a venous bleeding. Remember, a continuous SCW will develop into a tension = death.

Be sure to have the patient cough if possible just prior to applying the dressing and be sure that it is large enough to seal without being sucked into the wound as well.

 

[tydek07]

I have yet to see a sucking chest wound in the real world, but as R/r and MC have both stated... I have also heard that they really do not bleed much externally. I would be more worried about the wound causing a tension pneumo, then a little bit of bleeding coming from the wound. I am sure it is a basis-by-basis thing (as is everything in this line of work) and you will have to go with your gut feeling at the time. Just remember that the last thing this person needs is a tension... So get that occlusive dressing on ASAP and then listen to lung sounds, listen to lung sounds, listen to lung sounds.

 

[CAOX3]

I have used them a few times in the field. The most common are gunshot wounds and stabbings. As tyde stated tension pneumo is strong possibility as is hemothorax and tamponade.

They dont bleed much or I should say most of the bleeding is done internaly. These people need rapid assessmnet and transportation. There only hope usually is a surgeon.

When using them in GSWs you must also address the exit wound also, not just the entry wound.

The dressing itself wont do much for absorbtion of blood because it has a kind of glaze over it. I wouldnt worry to much about controlling the outward flow of blood because as stated above the majority is done internaly

They are pretty interesting injuries though, well if its not you that are the injured one. I had one you could actually hear the sucking sound in the ambulance. Another sign is a frothy blood with bubbling at the injury site.

 

[guamie]

Thanks for the replies everyone. I guess I was over thinking the solution. However, I didn't know that sucking chest wounds don't bleed much externally, so that would subsequently explain being able to apply an occlusive dressing so quickly. I do know that there are times where I can remove dressings, but I was referring to instances of deep, large lacerations that need constant control of bleeding. Again... thank you everyone.

PS - if anyone has any links to good videos showing ambulances running lights and sirens from first person point-of-view, post the link. I've found some on YouTube, but not a whole lot.

 

[medicdan]

I have had a few SCWs, again also GSWs and a stabbing-- although all my cases were all in Israel. There we carry 2 or 3 "Asherman Chest Seals"-- essentially just big stickers with a one way valve in the center. I have yet to see them in the US anywhere, but can say that I have seen them work well. Again, there is little bleeding, so they stick to the skin well. If it is on properly, you can actually hear the air escaping-- which indicates it is working well.

EDIT: Found a picture, and I guess it is available here...
http://firstrespondersupplies.com/acs.htm

 

[tydek07]

I have had a few SCWs, again also GSWs and a stabbing-- although all my cases were all in Israel. There we carry 2 or 3 "Asherman Chest Seals"-- essentially just big stickers with a one way valve in the center. I have yet to see them in the US anywhere, but can say that I have seen them work well. Again, there is little bleeding, so they stick to the skin well. If it is on properly, you can actually hear the air escaping-- which indicates it is working well.

EDIT: Found a picture, and I guess it is available here...
http://firstrespondersupplies.com/acs.htm

The volunteer service I use to help out with had them. They look at if they would work good. I have not seen them use anywhere else, included where I work now.

 

[reaper]

I have had a few SCWs, again also GSWs and a stabbing-- although all my cases were all in Israel. There we carry 2 or 3 "Asherman Chest Seals"-- essentially just big stickers with a one way valve in the center. I have yet to see them in the US anywhere, but can say that I have seen them work well. Again, there is little bleeding, so they stick to the skin well. If it is on properly, you can actually hear the air escaping-- which indicates it is working well.

EDIT: Found a picture, and I guess it is available here...
http://firstrespondersupplies.com/acs.htm

My last service has carried them for years. They do work well, but skin must be dry to get them to stick!

 

[DevilDuckie]

We carry Asherman Chest Seals and 4x4 Petrolatum Gauze. Never had to use either, however, only GSW's I've ever had were LRQ and Left Shoulder.

 

[HNcorpsman]

goes right back to ABCs... if a PT has a penetration to the chest and results in puncturing the lung, resulting in a sucking chest wound then there really shouldn't be to much blood. if it were me i would put some gauze over the wound to absorb the initial blood then, take the gauze off and put a occlusive dressing on the wound...

 

[medic417]

Be sure to have the patient cough if possible just prior to applying the dressing and be sure that it is large enough to seal without being sucked into the wound as well.

Theres something most books and schools fail to teach. Rid you need to write a book of things you need to know that the schools fail to teach.

 

[whizkid1]

I have never had a sucking chest wound.

 

[sir.shocksalot]

I have never had a sucking chest wound.

Me either, but I have seen them, and they look like they suck!
:lol::lol::lol::lol::lol::lol: