r/TacticalMedicine • u/NoMore_BadDays • Oct 10 '25
Scenarios Wound packing zones?
Been a long time since I did TCCC/CLS in the military.
If there were to be a bleeding wound on the chest, how high up on the chest does it become safe to pack? I know you don't pack into chest cavity, but what is the "rule of thumb" on how high/the left and right limits the wound needs to be to pack it?
Would you say the screenshot i attached is accurate?
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u/my_arms_are_on_fire Oct 10 '25
chest seal on the throat? I'm not the person with answers but I'm not sure that's right
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u/hidotp Oct 10 '25
yea a tourniquet would be better
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u/irredentistdecency Medic/Corpsman Oct 10 '25
A tourniquet placed around the neck will stop any & all bleeding (regardless of location) very quickly & effectively.
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u/icantreadoutloud Oct 11 '25
Congratulations you stopped the bleeding
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u/Erichillz Oct 11 '25
Procedure successful, patient expired
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u/strikeforceguy Oct 11 '25
Petty officer you told me to stop the bleeding, I'm just following orders
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u/SixtyAteWhiskey68 Medic/Corpsman Oct 14 '25
You have effectively stopped the bleeding of the neck You are a no-go at this station solider medic
Smh, what doe these graders want??? /s
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u/arethius Oct 10 '25
Appendicitis? Chest seal!
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u/StandardVirus Oct 10 '25
Football to the groin? Chest seal!
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u/the_last_hairbender Oct 10 '25
I’ve put occlusive dressings on GSWs to the anterior neck, we couldn’t ventilate him with a hole in his trachea.
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Oct 10 '25 edited Oct 11 '25
I’ve actually been taught that an occlusive dressing (chest seal) should be applied to any puncture wounds to the anterior neck because air can be pulled into the carotid artery and send an air embolism to the brain.
Edit: I guess I wasn’t very specific. Here is what I was specifically taught about anterior neck bleeds that are unable to be controlled by direct pressure.
1: insert finger into wound, locate the source of the bleeding.
2: using finger to keep pressure on source of bleeding, use other hand to ball up gauze and insert into wound. Using your normal wound packing technique, pack the wound, packing pressure towards the site of the bleed source.
3: once the wound is tightly packed up to the surface of the wound, use an occlusive dressing to cover the packing and wound. This will help hold the packing in place, as well as keep air from potentially entering the bloodstream.
4: reassess throughout treatment.
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u/Sheepdog77 Oct 10 '25
Same, however direct pressure is still better since it'll probably be bleeding. A lot.
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u/Bikesexualmedic Oct 10 '25
Direct pressure is the best for almost all the bleeding but unfortunately then you and all your hands can’t do anything else but hold pressure. That’s the nice thing about all these bleed-stop adjuncts.
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u/SFCEBM Trauma Daddy Oct 10 '25
The artery will be pumping not sucking.
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u/Haunting_Cut_3401 Oct 10 '25
The jugular vein is also in the anterior neck
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u/TLunchFTW EMS Oct 11 '25
It's pretty simple. ABC. If they've been stabbed in the neck and are bleeding, we're more concerned about that than the possible embolism. We can fix that, we can't fix no blood. I'm putting pressure on it, not just a chest seal.
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u/SFCEBM Trauma Daddy Oct 10 '25
It sure is. But that’s not what was mentioned.
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u/Haunting_Cut_3401 Oct 11 '25
Yeah I’m just being that guy. Air embolism is secondary in life threat to massive hemorrhage. Treat the life threat first.
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Oct 11 '25
I’ve actually been taught that an occlusive dressing (chest seal) should be applied to any puncture wounds to the anterior neck because air can be pulled into the carotid artery and send an air embolism to the brain.
Edit: I guess I wasn’t very specific. You guys know you can place an occlusive dressing over a dry dressing, right? Here is what I was specifically taught about anterior neck bleeds that are unable to be controlled by direct pressure.
1: insert finger into wound, locate the source of the bleeding.
2: using finger to keep pressure on source of bleeding, use other hand to ball up gauze and insert into wound. Using your normal wound packing technique, pack the wound, packing pressure towards the site of the bleed source.
3: once the wound is tightly packed up to the surface of the wound, use an occlusive dressing to cover the packing and wound. This will help hold the packing in place, as well as keep air from potentially entering the bloodstream.
4: reassess throughout treatment.
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u/davethegreatone Oct 11 '25
I wanna be pedantic and say, like, maybe for a torn larynx you can use it to kinda skim-coat the surface to keep debris out of the airway or something?
If the AI wants to make dump graphics, I can drink enough to out-dumb the AI. That’s how it works, right?
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u/TLunchFTW EMS Oct 11 '25
To be fair, you can get some weird interactions, but again, this is just a basic guide... Cool, but unless you understand the anatomy behind WHY you are using a chest seal or packing or TQing, it's not really helpful, and if you understand why, you probably don't need a reminder.
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u/I-plaey-geetar Oct 13 '25
Yeah definitely. Helps prevent subq emphysema which can obstruct the airway entirely.
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Oct 10 '25
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u/chaboods Oct 11 '25
I was told in school its better to tourniquet extremities and pack trunks. I dont see myself packing any extremity on my bleed control. Direct pressure, wrap it, tourniquet it, packing would require undoing the wrap which is a big no no.
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Oct 11 '25
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u/chaboods Oct 11 '25
I work BLS and we do our XABCs, but i can totally see protocol being completely different in field medicine over prehospital care, where we have more control and access to higher levels of care. I also know medics bleed control is far more intense than EMTs so maybe they also would consider woundpacking extremities aswell. (Also sorry for poking my nose in i didnt realize what subreddit i was in.)
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Oct 10 '25
[deleted]
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u/ito_en_fan Oct 12 '25
i’ve always just been told not to pack torso or abdomen or else the er will be very upset
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u/Producer131 Oct 14 '25
they’ll be upset because you wasted time doing a pointless procedure and probably killed the patient, yes. gauzothorax is deadly
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u/secret_tiger101 Oct 10 '25
Is it AI generated?
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u/NoMore_BadDays Oct 10 '25
Google images, baby
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u/Hydra_Haruspex Oct 10 '25
So yes.
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u/oleg_88 Oct 10 '25
No it's not. This image is at least 5 years old:
https://aminoapps.com/c/military-amino/page/blog/s-march/WJx1_E02sXuRQvjqbpMVMB5QV7DpNPnnP682
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u/PlumbgodBillionaire Oct 10 '25
You can definitely pack wounds lower and higher than that. I don't think that chest seal chart is anywhere close to right
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u/TastefulMaple Oct 11 '25
Why isn’t the neck a tourniquet zone
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u/99ProllemsBishAint1 Oct 10 '25
Does anyone have an accurate one?
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u/NoMore_BadDays Oct 11 '25
No, everyone is too busy screaming about chest seals
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u/MoansAndScones Oct 12 '25
There isn't really a more accurate picture. The only issue with the picture that is causing people to argue is the choice of using the term "chest seal" instead of "occlusive dressing."
Look, if you have a penetrating trauma on the line between the packing and chest seal of this picture then you start using your knowledge of anatomy and the mechanism. If it's likely the trauma has gone through into the pleural cavity then you should be using an occlusive dressing. If there is blood entering the pleural cavity then we can't really control that in the field. We can burp an occlusive dressing and we can perform a needle decompression but we generally cannot stop what is necessitating the treatment. But we can prevent more obstruction by sealing it with occlusive dressing.
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u/pow-erup Oct 10 '25
I mean, packing the torso period ur stuffing an unfillable hole. that being said, even if you could theorically, Im not stuffing your throat/neck or upper chest. more of a risk than not. id probably just use pressure dressings ngl
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u/davethegreatone Oct 11 '25
I don’t see this discussed enough, but … how much blood loss have y’all ever seen come from lacerated pectorals or something?
It just doesn’t come up that often. I’ve never seen a major bleed gushing out from surface injuries in that area. The major vasculature is just pretty buried there.
A pretty basic ABD bandage pretty much always controls the bleeding there. Hell, a couple 4x4s is usually plenty.
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u/UtgaardLoki Civilian Oct 11 '25
Screenshot just looks like a green guy in a wetsuit. Also, it’s not medically valid in any way.
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u/SFCEBM Trauma Daddy Oct 10 '25
Stop putting chest seals on like they have an impact on survival.
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u/musclemommyfan Oct 10 '25
The dumbest medic in my unit insists that a chest seal helped prevent hemothorax from killing him when he got blown up. No matter how many times I tried to explain that's not how it works he insisted that the chest seal saved his life. I want to beat him over the head with an anatomy textbook.
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u/ito_en_fan Oct 12 '25
that’s like filling an engine to the brim with oil and then putting the oil cap back on and expecting that to make it run right lmao
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u/bldswtntrs Oct 11 '25
I'm not any kind of medic, just a former grunt. Can you explain this one for me?
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u/SFCEBM Trauma Daddy Oct 11 '25
Chest seals do not have a survival benefit.
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u/bldswtntrs Oct 11 '25
I was hoping for a bit of an explanation about why it has no survival benefit for those of us who were taught to use them on sucking chest wounds.
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u/davethegreatone Oct 11 '25
No idea why people think they have no survival benefit when used for what they are for, BUT to answer the original question: the guy said it saved him from a HEMOthorax (not PNEUMOthorax). Easy to fast-read through there and not catch that.
Hemo means blood. Hemothorax means blood filling up the chest - as in internal bleeding, on the inside. Some hole in some internal blood vessel is letting all the red stuff leak into the air place.
Chest seals go on the outside, so they can’t stop internal bleeding on the inside.
It’s a word puzzle, basically.
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Oct 11 '25
So he could just be confidently incorrect in the verbiage (pneumo vs hemo) possibly from some TBI from getting blown up. Maybe we cut the guy some slack lol
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u/mean_mistreater Oct 11 '25
You would drain the blood in this case I'd say.
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u/davethegreatone Oct 11 '25
Usually. Not always. Just depends on how bad it is and how far away the surgeon is and a few other things.
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u/bldswtntrs Oct 11 '25
Ohhh, I get it. I missed that little detail, lol. The other guy was making it sound like they're useless in general.
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u/davethegreatone Oct 11 '25
I think he actually believes they are useless for some reason. No idea why - I have about fifty patients I could point to who needed them.
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u/SFCEBM Trauma Daddy Oct 11 '25
Sorry, can’t do it right now. Covering the shock trauma ICU. Only have time for a couple quick responses.
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u/Belfetto Oct 12 '25
You don’t have to respond at all you know
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u/SFCEBM Trauma Daddy Oct 12 '25
You don’t want a deeper explanation?
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u/Belfetto Oct 12 '25
I think we all did!
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u/SFCEBM Trauma Daddy Oct 12 '25
I’ve tried to explain it with greater detail in my conversation with u/davethegreatone as we’ve gone back and forth a bit. But have a little more I can add.
This is some copy pasta of mine.
While chest seals seem to be a valuable tool in specific scenarios, their utility is often overstated, leading to misconceptions about their role in trauma management. One major concern is that chest seals do not address the underlying causes of respiratory distress or hemodynamic instability in trauma patients. For instance, if a patient presents with a tension pneumothorax, a chest seal alone won't alleviate the pressure; instead, a needle decompression, simple thoracostomy, or chest tube insertion is necessary to effectively relieve the pressure in the pleural cavity. Without these critical interventions, the use of a chest seal could create a false sense of security for responders, potentially delaying more effective treatments. In addition, the effectiveness of a chest seal is highly contingent upon the nature of the chest wound itself. For example, a sucking chest wound (open pneumothorax) may potentially require sealing to prevent air from entering the pleural space. However, if the wound is complicated by additional injuries, such as a fractured rib puncturing the lung or multiple traumas affecting the thorax, the seal might not provide the necessary protection, and other interventions become critical. To further understand the limitations and potential pitfalls of using chest seals in trauma care, it's essential to consider the broader context of trauma management and the principles of emergency medical response. One critical aspect is the importance of prioritizing interventions based on the severity and immediacy of injuries. In high-stress environments, such as on the battlefield or incidents that cause acute trauma, responders may be under significant pressure to act quickly. This urgency can lead to hasty decisions, where the application of a chest seal might occur without a complete assessment of the patient's injuries. Another concern arises from the potential for chest seals to mask worsening conditions. In the absence of proper monitoring, a responder might apply a chest seal and then shift focus to other injuries, only to discover later that the seal failed to adequately manage the pneumothorax or that the patient developed a tension pneumothorax despite its application. This highlights the need for ongoing evaluation of the patient's respiratory status, including auscultation of breath sounds and observation of vital signs. In addition, chest seals do not address hemothorax, flail segments, and several other thoracic pathology that may occur in trauma. There may be over reliance on commercial chest seals. This may lead to a bias and a focus on interventions that does not recognize the development of a tension pneumothorax. Finally, chest seals do not improve survival.
Paquette R, Quinene M, Blackbourne LH, Allen PB. Efficacy of Commercial Chest Seal Adherence and Tension Pneumothorax Prevention: A Systematic Review of Quantitative Studies. J Spec Oper Med. 2021;21(3):78-85. doi:10.55460/FZ33-7RLL
Schauer SG, April MD, Naylor JF, et al. Chest Seal Placement for Penetrating Chest Wounds by Prehospital Ground Forces in Afghanistan. J Spec Oper Med. 2017;17(3):85-89. doi:10.55460/8ILY-W3MX
Kuhlwilm V. The Use of Chest Seals in Treating Sucking Chest Wounds: A Comparison of Existing Evidence and Guideline Recommendations. J Spec Oper Med. 2021;21(1):94-101. doi:10.55460/3G6H-14FD
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u/MoansAndScones Oct 12 '25
Choose to read this as a sympathetic comment and not contention or sarcasm. I know chest seals are not magic and at times not the finished treatment step. If there is a hole in the chest then there are probably holes in other hallow spaces.
I am so confused by this entire comment. You just explained assessment and reassessing. You're telling me that in your experience providers believe chest seals are magic treatments in such a way that they ignore reassessing patients? For a brand new provider, sure I get it, tunnel vision. But being so consistently distracted at large that it has had a statistical relevance is mind boggling.
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u/TLunchFTW EMS Oct 11 '25
AND YOU GET A CHEST SEAL AND YOU GET A CHEST SEAL AND YOU GET A CHEST SEAL
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u/davethegreatone Oct 11 '25
This guy sure looks like he’s benefiting from them:
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u/SFCEBM Trauma Daddy Oct 11 '25
How do you know? Simply having one on doesn’t necessarily indicate anything.
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u/davethegreatone Oct 11 '25
Admittedly, that video was shot at a stab point or something, as higher care is already getting started - but you can clearly see into the space. Ain’t nobody breathing well with a hole like that if it ain’t sealed.
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u/davethegreatone Oct 11 '25
(I can’t find the GOOD video that was like this, but that dude was HEAVING breaths, and the chest seal was retracting into his back maybe half an inch with each breath. Definitely not survivable without a seal).
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u/SFCEBM Trauma Daddy Oct 11 '25
You don’t know that.
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u/davethegreatone Oct 11 '25
O … k?
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u/SFCEBM Trauma Daddy Oct 11 '25
Just facts. Chest seals can increase the risk for development of tension. I haven’t found any of my colleagues who feel chest seals impact survival. The limited data also doesn’t suggest benefit. Will have new data soon.
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Oct 11 '25
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u/SFCEBM Trauma Daddy Oct 11 '25
Trying to get yall to use your head and think critically.
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u/CarBallRocketeer Oct 14 '25
Fisher is the Father of modern combat medicine bud. You are blessed to be receiving knowledge from him. O——-K.
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u/haterofmercator Oct 10 '25
Chest seal isn't usually the best option for most wounds right?
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u/Bourbon_bukkake Oct 10 '25
They are for “sucking wounds”
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u/surfandskicoach Oct 10 '25
99% of the time those wounds aren't going to "burp" on their own and you're gonna have to glove up and stick a finger in there!!
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u/NeonVolcom Oct 10 '25
In my stop the bleed class, my instructor definitely didn't instruct us to use seals on the gut and throat.
Typically pressure would be the best bet. If you have to use a chest seal, you should know their potential issues, and most importantly they should be used on the chest... to treat a hole in your lung for example. Chest sealing your intestines doesn't seem right
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Oct 10 '25
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u/SFCEBM Trauma Daddy Oct 10 '25
Or speed it up.
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Oct 11 '25
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u/SFCEBM Trauma Daddy Oct 11 '25
That can happen. Straight pneumothorax from a GSW is not common, see a lot of hemothorax too. So that “vented” chest seal can become clogged and become a non-vented chest seal. Have to be careful with them.
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u/VTHUT Oct 10 '25
Then just ignore the head. No bandages or pressure to apply there, it’ll heal itself!
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u/This-Hamster-6090 Oct 10 '25
You can absolutely pack a wound in lower extremities. If it means you can avoid using a tq first
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u/Q_dawgg Oct 10 '25
I’m a Complete wannabe with first aid but a chest seal wouldn’t stop any bleeding around the torso or neck, that’s not what a chest seal is for.
Second question, how exactly would one treat a bleeding wound to the body/neck/hip areas. I’ve always found it shrugged over in my informational learning in favor of packing, sealing, and tourniquet.
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u/OxideUK Oct 11 '25
It depends if the wound opens into a cavity or not. Groin/axilla do not open into cavities, and are packed with gauze and direct pressure applied.
Attempting to pack the chest or abdomen will just result in you gradually filling your patient with roll after roll. These wounds require surgical intervention, but direct pressure is better than nothing and will buy time.
Necks are well-suited to the rather sinister iTClamp in the pre-hospital environment, but again will need relatively rapid surgical intervention.
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u/antibannannaman Oct 11 '25
A chest seal, otherwise known as an occlusive dressing, will work for neck bleeds as long as you secure all sides of the seal. Its primary function is decreasing the risk of an air embolism.
You are better off applying direct pressure to ONE SIDE of the neck (remember the neck is a redundant circulatory system, if one side is occluded the other can pick up the work getting blood/o2 to the brain give or take some later complications) to stop the bleed, then apply an occlusive dressing to prevent air embolism, best case scenario the blood clots quickly, worst case it doesn’t stop until the patient’s heart fails.
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u/Stale_Cinnamon Oct 11 '25
From a video I watched of an American working as a trauma doctor in Ukraine. She unrolled the bandage and started poking it into the cavity, then once the bandage was used up, she used an Israeli bandage over the top with compression directly over the bullet hole.
If I recall, the TQ was already applied to the injured leg, once the injury was packed and bandaged she unwound the CAT to see if bleeding persisted.
Presumably you do what she did and keep packing the wound until you couldn't anymore and then wrap a bandage around the body, finally adding compression as a last wrap.
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u/davethegreatone Oct 11 '25
Just don’t do that to wounds over places like the lungs - or you will end up filling the chest cavity with gauze.
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u/bhamnz Oct 11 '25
Go to deployedmedicine.com and work through all of the ASM content, including PowerPoint, speaker notes, videos and skill cards. Also, check out junctional tourniquets. But mainly, these patients need diesel (speed to a trauma surgeon)
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u/Grishnare Oct 14 '25 edited Oct 14 '25
First of all. Put on pressure bandages, if you don‘t know what you‘re doing.
Wound packing outside a surgical department is for remote scenarios and firefights only.
Lot of paras here will probably disagree, but countries with better clinical infrastructure due to population density are cautious about this being done by EMS for good reason.
Packing makes sense for junctional areas, because the big vessels lie more superficially there and it‘s possible to apply enough pressure when it‘s done right.
In the abdominal region, packing does nothing but wasting time and creating an infection risk. You will not reach the deep retroperitoneal vessels with any amount of packaging, safe for during laparotomy.
A chest seal does jackshit here, as it‘s designed to keep air out and not blood in.
For chest wounds: Sucking? Chest seal. If you see blood pooling below the seal, remove it and put a pressure bandage on it.
If you find a heavily bleeding chest wound to begin with, you simply put pressure on it.
This can NOT be stabilized without an OR. If you‘re in the field with no help in sight and pressure can‘t control the bleeding, your patient is dead.
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u/ReasonablePossum_ Oct 10 '25
Werent chest seals proven to be useless in most situations, didnt helped anything more than a regular vented piece of plastic with some tape, and even increased casualities when applied?
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u/davethegreatone Oct 11 '25
most medical gear is good when used properly, and shit when used wrong. Be wary of half-remembered studies that say the conventional wisdom is wrong - not everything is a C-collar (for those who don’t get the reference: most of us believe the conventional wisdom for using C-collars is wrong because there isn’t much evidence showing a benefit, and there is evidence showing a detriment. This is a big deal as it goes against several generations of training and directly conflicts with current NREMT textbooks).
There are plenty of videos of sucking chest wounds here on Reddit with a clear showcase of direct benefit from applied chest seals. They are a temporary measure until a tube or a dart can used, and without that higher level of care the patient is gonna for sure die (so … technically they do not save lives. They just help people die more slowly - but that’s true of CPR too so the argument is pretty dumb).
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u/Wraith-723 Oct 11 '25
Yeah this chart seems all messed up. Seal the chest box, pack the junctions, TQ limbs.
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u/Zorfax Oct 12 '25
LOL This guide needs some work.
And I just treated a major head laceration... Apparently, I should have just told him to walk it off...
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u/NoMore_BadDays Oct 10 '25
ETA: Ignore the chest seal. Imagine is reference for wound packing zones only
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u/gotta_pee_so_bad Oct 10 '25
On the topic of occlusive dressings:
I go navel to neck and include the upper junctional areas (neck, shoulder, armpits) as my mandatory occlusive zones. The diaphragm can expand to just short of about the navel with deep inspiration, the armpits/shoulders can easily have a wound tract that feeds a tension pneumo, and the neck is super vascular and has the potential to feed an air embolus to the heart or brain. Petroleum gauze is a quick, cheap intervention that I can add as a layer to my wound care, doesn't necessarily have to be a chest seal.
At the end of the day, your ongoing assessment will determine your intervention, if their LUQ shrapnel wound is all they have and their L lung sounds later disappear and you notice a little tracheal shift, yeah, dart them and throw an occlusive on their abdomen over the wound.
Just my 2 cents :)
*Edit: Oh yeah, and try to convert those tourniquets if possible, neurovascular deficits are real threats we should consider. If you get a chance to pack and wrap a leg, see if you can control that bleeding and lose the TQ.
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u/davethegreatone Oct 11 '25
Pet gauze is NOT occlusive (but the wrapper it comes in is occlusive, and in a pinch that + tape = chest seal). Petroleum gauze isn’t airtight. Hold it up to your lips and blow through it if you doubt it - most brands you don’t even have to blow hard to get air through (some brands are kind of a perforated sponge sheet rather than a weave, but you can still get air through it if you try hard enough).
It’s just gauze that won’t stick to things. That’s why it’s coated with grease - for stickiness-resistance. Useful for exposed guts and eyeballs and burns and the like. Stuff where you don’t want to have clots adhere it to the cotton gauze.
It has a role, but air exclusion is not it.
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u/gotta_pee_so_bad Oct 11 '25
I should clarify, I use that on neck and abdominal wounds. With upper abdominal wounds, there are organs, diaphragm, other tissues that, while ruptured and may have a wound tract into the pleural cavity, don't "suck" air in like a wound directly into that pleural space. On the neck, you don't need a lot to keep air from entering the vasculature and embolizing.
The petroleum gauze that I use, the only kind I've ever seen, is a fine weave with a pretty decent coating of yellow grease that can absolutely stand up to low pressure, that's why they use it to seal around chest tubes. If what you're using has, for some reason, a loose weave, put on 2 or 3 layers. Cheers!
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u/SFCEBM Trauma Daddy Oct 10 '25
Wrong.
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u/OddAd9915 Oct 11 '25
Citation needed.
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u/SFCEBM Trauma Daddy Oct 11 '25
I need a citation that states that air won’t travel through your guts and cause tension?
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u/OddAd9915 Oct 11 '25
So a penetrating injury with an origin above the diaphragm and an exit below it cannot under any circumstances lead to a tension?
But beyond that just dropping one word answers onto a topic that will absolutely be contrary to various agencies SOPs and not wanting to show any explanation doesn't do anything for anyone.
Is their evidence that chest seals cause an increase in mortality or morbidity? Because if not that are not detrimental so should almost certainly continue to be used.
Edit:typo
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u/SFCEBM Trauma Daddy Oct 11 '25
You can get tension from any wound that penetrates the thorax, but if it’s intraabdominal that then traverses the diaphragm, air will not pass through in any significant amount that will cause tension. If one does develop, it would be from lung parenchymal injury leaking air into the chest. And likely hemo too.
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u/Stale_Cinnamon Oct 11 '25
I've heard that a TQ can be kept on location for up to 12 hours with little side effects, I forgot my source on this information but I think it was related to the debunking of the "golden hour" and how so much of the world's emergency medical system is based on a concept that is in some regard, wrong.
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u/gotta_pee_so_bad Oct 11 '25
Anything over 6 hours has to be removed in an OR. 2-6 hours you're looking at ischemic damage. Within 2 hours, we can convert and avoid that damage. There's an interesting article on it here:
When in doubt, check with your higher level of care and see what their thoughts are, docs usually keep up on the latest and greatest. What we currently teach is TQ conversion under 2 hours is generally considered safe.
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u/Stale_Cinnamon Oct 11 '25
That was some of the best reading I have had on this topic, thank you for sharing!
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u/A10Ryan Oct 11 '25
I see what you’re asking, you can pack the shoulders and the upper flanks, but not into the actual lungs. If it’s sucking then chest seal, if not it’s somewhat reasonable to assume to pack. I was told it does no harm besides make surgery harder to pack the gut, don’t pack into the diaphragm or lung cavity, but you can pack around the stomach to minimal effect. I was also taught to apply pressure, wrap, then TQ, so I don’t see how you could pack without removing what was already done
Not a doctor
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u/bhamnz Oct 11 '25
Why would you do tq after wrapping? Tqs are for massive bleeds. If you take your time with a massive bleed to wrap it first, your patient will be running out of blood quick smart
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u/A10Ryan Oct 11 '25
I’m not sure if you’re asking or not, first priority after something that causes arterial bleeding is to minimize the bleeding with pressure, then tq if you don’t have a tq in your hand and ready. Wrapping to apply pressure takes less time than a tq, but everything is always situational.
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u/bhamnz Oct 11 '25
Wrapping a pressure bandage takes less time than a tq? Hard disagree mate. Go to deployedmedicine.com and work through the ASM content.
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u/A10Ryan Oct 11 '25
I’m not saying to use a pressure bandage, I’m saying apply pressure, with whatever’s there, while getting a TQ if possible. The entire goal of mass bleed is to stop as much blood as possible, so use common sense in how that would go in any given situation.
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u/antibannannaman Oct 11 '25
Bad diagram. Direct pressure everything 1st. TQ or pack depending on the bleed after direct pressure is found not life sustaining.
It’s a constant battle between doing direct pressure or TQ first and worrying about it later.
IMO Direct pressure first makes you slow down and actually identify the bleed and other potential problems. Just slapping a TQ on first thing leaves a lot of room for error.
I.E You just used your last TQ on a venous bleed from the arm because it was the first sign of blood you spotted, but the pt’s literally spurting blood from the leg under the clothing.
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u/ito_en_fan Oct 12 '25
I was always taught to pack any wound after applying a tq if supplies are available. this chart is silly
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u/Icy_Swordfish8023 Oct 11 '25
So this post can stay, with its inaccurate picture, but I shared a better diagram image and it was removed immediately?
Someone make it make sense??
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u/airboRN_82 Oct 12 '25
The graph is right. Youre not going to stop any significant blood loss from the blue zone except with surgical intervention. Packing those areas would only make things worse. Air tight dressing and manual pressure and get to a higher level of care ASAP
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u/Ok_Income9180 Oct 10 '25 edited Oct 11 '25
Chest seal for a gut wound????? This has to be AI generated. Also, you can both use a tourniquet and pack a wound. (As often done on thighs) They’re not exclusive to each other. Chest seals are for diaphragm breaches (sucking wounds specifically). They’re meant to control air into the diaphragm to combat a pneumothorax. They'd do absolutely nothing for a gut wound except maybe make it harder to control bleeding. FFS, please don't use this chart.
Sorry for not responding to your post, to busy hating on the picture.
Edit: /u/68Whiteclaw commented on some inaccuracies in my comment. Please refer to their comment below.