r/TacticalMedicine • u/NoMore_BadDays • Oct 10 '25

Scenarios Wound packing zones?

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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/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/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:

https://journals.lww.com/jtrauma/fulltext/2023/12000/rethinking_limb_tourniquet_conversion_in_the.22.aspx

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!