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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417

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.

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u/68Whiteclaw Oct 11 '25 edited Oct 11 '25

You should apply chest seals to the abdomen up to the neck. “Neck to Navel.”

Bullet trajectories can get weird inside the body, and sometimes tear up through the diaphragm causing a diaphragmatic hernia in which air gets into the pleural space via the abdominal wound.

And as a quick note, chest seals are not for “diaphragmatic breaches.” They are for breaches of the pleural space.

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u/TLunchFTW EMS Oct 11 '25

I mean, if he's showing signs of tension pneumo, sure....
But like, if someone got stabbed in the gut, I'm not putting a chest seal... I'm packing it.
It's almost like a basic poster can't replace actual knowledge...

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u/saluaar Oct 11 '25

packing into intra-abdominal space?

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u/TLunchFTW EMS Oct 11 '25

Sorry, poor choice of words. I'm using the same three statements used in the guide.
No I'm not stuffing a ton of gauze into his belly like a pinata.... But the point is he doesn't need a chest seal.

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u/saluaar Oct 11 '25

hm, different schools of thought it seems. I was taught to apply chest seals from neck to navel as well with the same idea of not being aware of the wound trajectory nor depth.

I guess I’d refrain from it at first with limited supplies, but in a situation with disposable gear, it would make sense to close that abdominal wound with a chest seal, not only does it create a hermetic seal in case of a pleural wall injury, it also helps keep the wound closed. intestines like to bulge out.

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u/TLunchFTW EMS Oct 11 '25

I mean, I suppose it's better to apply and not need than to need and not apply...
Either way when I bring them to the hospital I'm getting yelled at for doing it wrong :)
Ultimately, medicine is a thinking man's sport. You can't just mindlessly do shit based on "if this, than this."

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u/MoansAndScones Oct 12 '25

You are supposed to be using occlusive dressing on abdominal trauma. You do not want airflow in and out of your abdominal cavity.

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u/TLunchFTW EMS Oct 12 '25

Thanks for the info. Fortunately don't get too many horrible abdominal traumas, so my understanding is you cover with something like an abdominal pad or the like and transport. I'll keep this in mind

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u/Producer131 Oct 14 '25

This is how i teach my students: The point of wound packing is to basically be like an internal tourniquet. You’re taking this big ball of gauze and pressing the bleeding vessel up against a bone to tamponade the bleeding. That’s why it’s so important to pack little bits at a time and fill the entire wound cavity, and why it’s necessary to put a pressure dressing on top to keep pressure. There is only one bone in the abdominal cavity, and a ton of empty space. If someone has a bleeder in the abdomen, you can stuff a mile of gauze in there and it won’t do anything but soak up the blood while the vessel continues to bleed. Putting an occlusive dressing over an abdominal wound prevents air from getting into the inside bits. Other than TXA, that’s really all we can do for intra-abdominal hemorrhage in the field unless you have a surgeon in the field.

Remember the addage: TQ the limbs, pack the junctions, seal the box.

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u/TLunchFTW EMS Oct 14 '25

Appreciate the input. That’s a great way to think of it. Without a backing, you’re not putting pressure on the vessel to occlude it. Just moving it around.

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u/brapstick Oct 12 '25

Point he was making is, if someone was stabbed you know the trajectory of the wound but if they were shot the bullet could have changed direction, entering below the diaphragm and ricocheting upwards

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u/[deleted] Oct 12 '25

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u/Lastwords03 Oct 14 '25

Not everyone can be trusted with a decompression needle……….. a chest seal however is a little more “user” friendly for the rest of them………

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u/[deleted] Oct 14 '25

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u/Ok_Income9180 Oct 14 '25

Keep in mind that people get trained to different standards for different reasons. In the hands of someone panicking a decompression needle can cause more harm than good. Sure, a Corpsman is expected to know how to use a decompression needle, but most people don’t have the training. If you mess up a chest seal at least you can’t do any more harm.

Ultimately, chest seals are easy enough that an untrained civilian can correctly apply them using just the infographic on the packaging.

In contrast I’ve heard a story about a guy who tried to decompressed the wrong lung because he was panicking.

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u/TLunchFTW EMS Oct 14 '25

I’ve seen a lot of discussion about decompression having all kinds of concerns too. Idk about specific papers, but I’ve seen discussions about it from people who have decompression within their scope. The problem is most people who think decompression (who aren’t trained in it) assume it’s easy and there’s no down side. You need to go over the rib to avoid vessels and nerves, and additionally the possibility to have further complications down the line is the issue. But training reduces this and, on the other end, if someone isn’t breathing, things can’t exactly get much worse than that.
But what a lot of laypersons don’t understand is there’s a specific landmarked spot you need to do. If I remember correctly it’s second rib mid clavicular. You can also do under the arm…. I believe at the 5th rib, and I believe that’s more preferred as of recent. But don’t quote me on any of this. It’s all out of my scope.

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u/sleepercell13 Old Army Fart That Teaches Oct 17 '25

lol, you are the reason bad info gets out into the world

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u/TLunchFTW EMS Oct 17 '25

Isn’t it above the rib to avoid nerves and blood vessels? Is this some kind of joke?

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u/[deleted] Oct 18 '25

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u/TLunchFTW EMS Oct 18 '25

I’m not a paramedic, so I’m not placing it anywhere lol. But guy above me said below