Venigard/Tegaderm over GSW

[Akulahawk]

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.

 

[MotorCity]

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.

 

[Akulahawk]

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!

 

[MedicBender]

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?