If you have a patient that has a pneumothorax due to external trauma, after you put on an occlusive dressing and create a flutter valve (by taping down only 3 sides of the dressing), could you use positive pressure ventilations via a BVM to try and reinflate the lung and push the air back out the hole?
Pneumothorax "what if"
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Brandon O
Puzzled by facies
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Yes. And if they need ventilatory support, you shall do so. Just make sure your flutter valve is actually venting.
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Is the patient breathing adequately on their own?
Do you mean a scenario where you tell the responsive and breathing patient "Grip tight dude, I'm gonna inflate your collapsed lung with this BVM real quick." Helllllll no..
If the patient IS breathing adequately with their remaining lung, do you intend to force air into a collapsed lung for them? Most humans have two lungs, they don't need both to stay alive..
If the patient isn't breathing adequately, why do you think you wouldn't?
Do you mean a scenario where you tell the responsive and breathing patient "Grip tight dude, I'm gonna inflate your collapsed lung with this BVM real quick." Helllllll no..
If the patient IS breathing adequately with their remaining lung, do you intend to force air into a collapsed lung for them? Most humans have two lungs, they don't need both to stay alive..
If the patient isn't breathing adequately, why do you think you wouldn't?
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Remember the reason you're putting that occlusive dressing on at all. If this is a sucking chest wound that has caused a pneumothorax, your occlusive bandage taped down on three sides allows the patient to inhale and draw air in effectively by sealing up the external hole. Excess pressure "should" be what's vented out of the bandage. If you think too much pressure is building up and the lungs are not inflating (tension pneumothorax), it's probably because your occlusive bandage is sealed too well. If you see increasing shortness of breath, worsening hypotension, tachycardia, JVD, diminished lung sounds, and god forbid tracheal deviation, take your occlusive dressing off! This provides treatment based on the same theory as a needle decompression or chest tube placement.
Positive pressure ventilation may be enough to break the seal on the occlusive dressing and allow venting, or it might make the problem worse if the seal stays shut. The moral of the story is to think through the science and physics of where the pressure is building up and how you can alter it.
Positive pressure ventilation may be enough to break the seal on the occlusive dressing and allow venting, or it might make the problem worse if the seal stays shut. The moral of the story is to think through the science and physics of where the pressure is building up and how you can alter it.
mycrofft
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Stray shots:
1. If the lung has been breached BVM will not help the bad lung, but push more air into the space and collapse it more. Can you positively tell if that happened or if it is simply a breach to the outside? Check opposite side breath sounds, BVM them if needed, but don't expect it to help the bad side.
2. This can become a case of the dog catching the car. At a basic care level what care options do you have? How long will they take versus getting to a local receiving facility? Will this save a life or reduce pain? Once it is set up, then what?
3. The typical occlusive dressing (vaseline gauze) takes a lot of pressure to vent through and does not want to fall back into place. Improvised Heimlich valves made from glove fingers have been cited but not for something you plan on. Using the sterile side of the foil or plastic wrappers for vaseline gauze, Adaptic etc. are easier to use than greasy bandages but still do not vent and reseal very well. Medics in Nam were known to use any cloth (including bloody socks) to seal a sucker but not try to vent it.
If the whole three-sealed bandage thing worked well, hospitals would use those instead of expensive water seal setups. Seal it, turn them onto the affected side (presuming there aren't two affected sides), treat CAB's, get to hospital while monitoring. Right?
Advanced people: 1. Can bagging a closed pneumo cause secondary issues through mediastinal shift?
2. IS oxygen really useful here?
3. What are our time elements here? Is it better to get going than try to establish a three-sealed cover?
4. Anyone actually see one of those work?
1. If the lung has been breached BVM will not help the bad lung, but push more air into the space and collapse it more. Can you positively tell if that happened or if it is simply a breach to the outside? Check opposite side breath sounds, BVM them if needed, but don't expect it to help the bad side.
2. This can become a case of the dog catching the car. At a basic care level what care options do you have? How long will they take versus getting to a local receiving facility? Will this save a life or reduce pain? Once it is set up, then what?
3. The typical occlusive dressing (vaseline gauze) takes a lot of pressure to vent through and does not want to fall back into place. Improvised Heimlich valves made from glove fingers have been cited but not for something you plan on. Using the sterile side of the foil or plastic wrappers for vaseline gauze, Adaptic etc. are easier to use than greasy bandages but still do not vent and reseal very well. Medics in Nam were known to use any cloth (including bloody socks) to seal a sucker but not try to vent it.
If the whole three-sealed bandage thing worked well, hospitals would use those instead of expensive water seal setups. Seal it, turn them onto the affected side (presuming there aren't two affected sides), treat CAB's, get to hospital while monitoring. Right?
Advanced people: 1. Can bagging a closed pneumo cause secondary issues through mediastinal shift?
2. IS oxygen really useful here?
3. What are our time elements here? Is it better to get going than try to establish a three-sealed cover?
4. Anyone actually see one of those work?
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3 characters.
mycrofft
Still crazy but elsewhere
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I used the scissors to flip it out of the package. Tape and Vaseline don't mix.
OP, get this?
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Agreed. That stuff works like a champ to seal chest wounds. Generally sticks better to a real diaphoretic patient than regular tape will as well. It's my go to for chest wounds, we don't carry any fancy chest seals.
Like someone else said, unless the patient is presenting with ventilatory insufficiency I'd just seal it, titrate O2 to an acceptable SpO2% and transport them while watching them carefully, I'd ask for ALS as well and meet them en route if it makes sense, if not then just let the ER do their thing. While ALS can decompress a tension pneumo with a needle thoracentesis this patient ultimately needs a CXR and an MD to decide if they need a chest tube or not and potentially intubation.
mycrofft
Still crazy but elsewhere
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In a pinch...diaphoretic EKG electrode or AED pad?
I think the "three sided seal" bandage deal is wishful thinking.
I think the "three sided seal" bandage deal is wishful thinking.
forget the pad, just use the packaging.
Back in the day we just kept sterile aluminum foil of the truck. It worked great.
mycrofft
Still crazy but elsewhere
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As a seal, right? I'm talking about trying to make a bandage act as a flapper valve.
Brandon O
Puzzled by facies
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Anybody used a Tegaderm?
I never had one big enough, but I don't see why you couldn't.
mycrofft
Still crazy but elsewhere
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The ASherman
The Bolin:
Or at this website (Internatinal Red Cross Surgery for Victims of War, 1998): http://helid.digicollection.org/es/d/Jh0218e/14.3.1.html
But these are NOT basic level interventions! Take a class or three.
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Tegaderm/OPSITE etc: a doctor told me once it was "pesky" to work around those filmy materials, ditto Saran wrap.
The Bolin:
Or at this website (Internatinal Red Cross Surgery for Victims of War, 1998): http://helid.digicollection.org/es/d/Jh0218e/14.3.1.html
But these are NOT basic level interventions! Take a class or three.
========
Tegaderm/OPSITE etc: a doctor told me once it was "pesky" to work around those filmy materials, ditto Saran wrap.
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But these are NOT basic level interventions! Take a class or three.
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Tegaderm/OPSITE etc: a doctor told me once it was "pesky" to work around those filmy materials, ditto Saran wrap.
I have found that you really don't need the flapper over the needle.
yup..call ALS. There is really nothing I am going to do at the BLS level to fix a pneumo. I suppose I should stop trying to think outside the box :wacko:
Brandon O
Puzzled by facies
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Don't be upset by that. It takes a few days for a pneumo to right itself. The medical care including a chest tube is really just to manage the pressure, not actually fix the problem.