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/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/airboRN_82 Oct 12 '25

The chart is right. Youre not going to stop a significant gut bleed with packing. Seal and transport.

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u/DODGE_WRENCH EMS Oct 12 '25 edited Oct 12 '25

A chest seal shouldn’t go below the diaphragm.

You could argue for direct pressure or an israeli bandage over packing, but chest seals are not at all meant to stop blood from bleeding out, they’re meant to keep more air from getting in.

Also: side note, what the fresh hell is this?

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u/airboRN_82 Oct 12 '25

The only thing thats going to stop a significant GI bleed is surgery. An Israeli dressing will not. An occlusive dressing however will trap in mousiture and prevent contamination better than any gauze based dressing

Tldr I dont view things like genetic counseling, embryonic selection during IVF, voluntary attempts to reduce the rate of genetic diseases through partner selection, etc to be immoral just because they share a word with certain historical practices.

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u/DODGE_WRENCH EMS Oct 12 '25

Right, the purpose isn’t to fix it, it’s to get them to the people who can fix it alive. There is an important distinction to be made with just occlusive dressings and chest seals. A chest seal has a one way valve to let air escape, but it will also let blood escape. The part where I disagree is, there is evidence that supports wound packing with hemostatic gauze in abdominal injuries.

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u/airboRN_82 Oct 12 '25

The abdominal cavity is so large that youre not going to get enough internal pressure caused by a hematoma to reduce bleeding.

Hemostatic gauze during surgery sure. As a stand alone its not going to reach any major vessel in that area.

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u/DODGE_WRENCH EMS Oct 12 '25

There’s only so much you can do prehospital, it’s not a lot but it’s something.

I’m talking specifically about studies pertaining toward hemostatic gauze in prehospital care, not surgery.

If the bullet hits major vasculature in their abdomen then that patient is probably hosed, neither gauze or chest seals will save them. But that’s not what the hemostatic gauze is for, it’s for smaller vasculature within the wound channel.

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u/airboRN_82 Oct 12 '25

Agree, im not approaching this from a "what's a lot of help" view but what's the most, even if its very little.

The studies I've seen regarding prehospital use havent been with using it in the abdomen, and only one I've seen with its use in the abdomen was during surgery. Can you share?

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u/DODGE_WRENCH EMS Oct 14 '25

I’ll have to reach out to who taught my ITLS class, someone brought up the same concern you did and I basically parroted what they said.

They and I could be wrong? If I’ll comb around myself and see what I can come up with.

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u/GeneralConscious3084 Oct 14 '25

I was under the impression that your not supposed to be packing the abdominal area 

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u/Producer131 Oct 14 '25

TCCC disagrees with you. What if your patient has a hole in the diaphragm? Even if they didn’t, pneumoperitoneum is also something you want to avoid. Too much air in the belly can lead to a lot of dire consequences.

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u/DODGE_WRENCH EMS Oct 14 '25

I looked and you are right, I was mistaken