PDA

View Full Version : Questions About Sucking Chest Wound


Pete E
06-04-2010, 15:32
Hi Gents,

During my 72 hours in new member quarantine , I used the time to do some reading/research on previous threads concerning Sucking Chest Wounds and Pneumothorax.

First I should say that the little medic training I had was in the British equivalent of the NG, and that was over 20 years ago, so please go easy on me!

As I undertsand it, a sucking chest wound results in a collapsed lung on the injured side and this would be termed a "simple pneumothorax"??

Although the pt may be short of breath, this type of pneumothorax doesn't require any invasive procedures and is usually treated by sealing the holes either completely, or with a "vented seal" either improvised or using something like an ACS??

However in a previous thread here (http://www.professionalsoldiers.com/forums/showthread.php?t=18532&highlight=valve&page=3) Swatsurgeon writes:

"IF and when a patient becomes symptomatic (non-intubated pt.), time for a 3 sided dressing/ACS, etc. All patients with positive pressure being applied via ETT or BVM, don't need one. A dressing somewhat reduces the future contamination (above and beyond what has already occured). The fact is that you have to watch these people like a hawk....if the open end is not letting go of the air, they get a tension PTX.."

My first question is why don't Pts on positive pressure ventilation need a dressing? I guess what I'm saying is that I'm having trouble visualising how postive pressure aids a collapsed lung? Is it that the postive pressure overcomes any residual pressure build up in the pleural space?

Moving on to the more serious tension pneumothorax, does a simple pneumothorax usually progress to this?

Also, If using positive pressure on a pneumothorax, does that encourage air to leak from the damaged lung into the pleural space, causing the pressure to build and the condition to progress to a tension pneumothorax??

I am hoping these questions will spark discussion on the subject as well result in a few direct answers...

Regards,

Peter

( PS,Please use laymans language so a Sun reading Brit has a chance to follow! :D )

Red Flag 1
06-04-2010, 16:14
Pete,

In the mechanics of breathing, there is a negative pressure in the plural space, during inspiration.The pleural space is between the lung and the inside of the chest wall (ribs). This pleural space negative pressure allows air enter the respiratory system, with the end organ being the lung. In a sucking chest wound, the negative pressure on inspiration pulls air from outside into the chest through the "sucking" wound. Generally the air will move through the wound in both directions. Can't add much to what SwatSurgeon has already said.

In a tension pneumothorax, generally a ruptured bleb (weak spot in the lung) allows inspired air to find it's way through the lung, through the rupture and into the pleural space. In a tension Pneumo, the air does not pass back out through lung and becomes trapped within the pleural space. Each inspiration adds more air to the trapped air volume in the plueral space and compresses the lung. Over time, an entire lung field can be compressed and bring pressure to other structures such as the heart. A tension Pneumo is an emergency and can be life threatening, rather quickly in some cases.

Hope this helps a bit.

RF 1

Pete E
06-04-2010, 16:39
RF-1,

Thanks for that, it does help...

With regards the dressing used, IIRC initially we were taught to put an improvised 3 sided dressing over each hole, (ie entry and exit) and then in later years it switched to a fully sealed dressing on both holes, but now I think its reverted back so to speak as ACS and laterly Bolin's are being issued.

Our hunting club has range training days about 3 times a year, so there is always the worry of an ND and somebody suffering a GSW.

Considering the terrain, location, and other circumstances, I estimate it would take an ambulance about 20mins to 45 mins to reach a casualty, so I am trying o brush up on the basics to have a fighting chance if the SHTF,

Regards,

Peter

JJ_BPK
06-04-2010, 19:32
RF-1,


Our hunting club has range training days about 3 times a year, so there is always the worry of an ND and somebody suffering a GSW.

Considering the terrain, location, and other circumstances, I estimate it would take an ambulance about 20mins to 45 mins to reach a casualty, so I am trying o brush up on the basics to have a fighting chance if the SHTF,

Regards,

Peter

Peter

Your club should spend a couple quid and have the ambulance on site during live fire activities.

Here in the colonies, the local fire department can usually schedule attendance, sometimes free. In some instances, it is mandatory, or the function will lose its insurance coverage.

Vice President Chaney is a strong advocate of advanced medical planning at field shooting events.

As to a pneumothorax, I have 1st hand experience with one. I was unfortunate to get into a frag contest with an individual who had the luck to be in a bunker with a 6 inch thick door. I was laying on the side of a dry rice paddy.

I lost.

The chunk of shrapnel was the size of a fava bean and wedged between two ribs. My medic used a plastic battery case to seal the wound. The wound felt as if someone was kicking my ribs with each breath. Best I could do was pant and try not to go into shock. I believe this may have kept the plural liner from collapsing.

I was transported to the local MASH unit, where the battery bag held until they transferred me to the gurney in the x-ray room. The drop from the x-ray table to the gurney, maybe 2 inch, was enough to cause the patch to slip and my left lung to collapse. As they had cutters and a gas guy standing by, the results were positive.

The surgeon later told me that the plural liner did not ripped and had no holes..

I was lucky.

Now, every year I donate to the Energizer Bunny Retirement Home.

:lifter

Red Flag 1
06-04-2010, 19:55
RF-1,

Thanks for that, it does help...

With regards the dressing used, IIRC initially we were taught to put an improvised 3 sided dressing over each hole, (ie entry and exit) and then in later years it switched to a fully sealed dressing on both holes, but now I think its reverted back so to speak as ACS and laterly Bolin's are being issued.

Our hunting club has range training days about 3 times a year, so there is always the worry of an ND and somebody suffering a GSW.

Considering the terrain, location, and other circumstances, I estimate it would take an ambulance about 20mins to 45 mins to reach a casualty, so I am trying o brush up on the basics to have a fighting chance if the SHTF,

Regards,

Peter

If your range is that far from medical response, get the medics to feel good about being there Pre-SHTF.

As for treatment, I'm just the "gas guy" JJ mentioned. Thus treatment plans are probably better discussed by some of the trauma level folks here. That having been said, supplemental oxygen support would be in order. Air occlusive dressings seem to be a good idea as well. As for positive pressure airway support, I can say that it would go a long way to re-expand the down lung if needed for patient survival.

BTW, nice audio signature:cool:.

RF 1

Green Light
06-04-2010, 20:14
BTW, nice audio signature:cool:.

RF 1

From Zulu? Same unit?

Red Flag 1
06-04-2010, 20:19
From Zulu? Same unit?

Wondered that myself.

Great flick!!

RF 1

JJ_BPK
06-04-2010, 20:19
As for treatment, I'm just the "gas guy" JJ mentioned. Thus treatment plans are probably better discussed by some of the trauma level folks here.

RF 1

Should have prefaced: Just a little 40 yr old experience,, not current in any fashion..

Pete E
06-05-2010, 07:13
Your club should spend a couple quid and have the ambulance on site during live fire activities.

Here in the colonies, the local fire department can usually schedule attendance, sometimes free. In some instances, it is mandatory, or the function will lose its insurance coverage.


That is certainly one posibility, but up to now, the way the range days are run has produced a very safe environment.

The guys in charge are qualified range personel (either ex Services or Civilian) and a couple of years ago changes in our training programe also mean that all intructors will have to have a basic "First Aid At Work" qualification.

While this is a very rudimentry First Aid qualification, I feel its a step in the right direction and I strongly support continued upskilling in that area. The introduction of this FAAW qualification also meets the requirements for the insurance liability you mentioned, plus our possibile obligations under UK employment law.

Also the way the club is organised, we have people out hunting nearly everyweekend of the year, plus as we have our own Larder for carcass handling/cutting, so more first aid training has got to be a good thing.

Regards,

Peter

Pete E
06-05-2010, 07:53
From Zulu? Same unit?


Men of Harlech was a Regimental March of my former unit the Royal Welch Fusilers and we marched off the parade square to it at my Passing Out Parade, so it means a lot to me.

(Incidently the Royal Welch Fusiliers fought at Bunker Hill and York Town to name a couple of battles you may have heard of! So I guess you can say you have a former Red Coat in your ranks! :D )

With regards Rorke's Drift, the film is not entirely accurate. The unit that fought there was the 24th of Foot.

British Regiments weren't stricktly recruited on geographical basis, despite their names. In this case, the 24th Regiment of Foot was an English regiment that had been stationed in South Wales a few years before this action and it was ome years later renamed "The South Wales Borderers".

In later years, and especially through the film "Zulu!" the Welsh aspect has been played up, when in fact the nationalities of the Regiment were mixed.

There is a good write up about the film here: (http://www.rorkesdriftvc.com/zulu.htm)

Still, what ever the fine detail of the history, the battle exemplified the epitome of bravery by both sides. 140 odd British troops armed with Martini Henry rifles against 4500 Zulu's, mostly with just hand weapons. 11 Victoria Crosses "were earned before breakfast"

In 2006, on a very sad day, the Royal Welch Fusiliers ceased to exist after 317 years of continous service to the Crown when they were amalgamated with the Royal Regiment of Wales (its self a decendent of the South Wales Borderers)

The new unit is the The Royal Welsh Regiment and is a light infantry unit that has already served with distinction in Afghanistan.

Sorry for going off topic!

Regards,

Peter