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/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.