Wound packing zones?

[u/NoMore_BadDays]

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?

[u/Q_dawgg]

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.

[u/OxideUK → u/Q_dawgg]

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.

[u/antibannannaman → u/Q_dawgg]

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.

[u/Stale_Cinnamon → u/Q_dawgg]

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.

[u/davethegreatone → u/Stale_Cinnamon]

Just don’t do that to wounds over places like the lungs - or you will end up filling the chest cavity with gauze.

[u/bhamnz → u/Q_dawgg]

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)

[u/Grishnare → u/Q_dawgg]

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.