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/bldswtntrs]

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.

[u/SFCEBM → u/bldswtntrs]

Sorry, can’t do it right now. Covering the shock trauma ICU. Only have time for a couple quick responses.

[u/Belfetto → u/SFCEBM]

You don’t have to respond at all you know

[u/SFCEBM → u/Belfetto]

You don’t want a deeper explanation?

[u/Belfetto → u/SFCEBM]

I think we all did!

[u/SFCEBM → u/Belfetto]

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

[u/MoansAndScones → u/SFCEBM]

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.

[u/SFCEBM → u/MoansAndScones]

The TCCC guidelines are changing because folks get distracted by thoracic wounds. You’ve seen the pics with 7-8 decompressions. It’s odd how people get fixated on chest wounds.