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Old 06-13-2008, 14:28   #36
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Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
You answered it perfectly.....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. I haven't found a reliable tape or adhesive that sticks well to the body when it is dirty, slimy from sweat, etc. I haven't tried duct tape but I will now to see if it holds.

Back to the original issue: what method works most reliably for these wounds?
So far multiple people have used different methods to seal the chest. Can we safely say there is no one standard? Any product that can form a barrier to the inflow of air and yet release it when necessary would seem to work......
$15 for an ACS, <$1 for saran wrap and duct tape and everything in between.

Needle decompression for tension PTX: need a needle that is 3-3.5 inches long, longer and placed in the incorrect place, you harpoon the heart or lung potentially. How many to carry on your self??? I say 5. They bend too easily and repeat decompressions are >60-70% likely. Little weight and little size, so more is better. My record was 7 in one side....he lived to the hospital.

Prep pads: alcohol and betadine....why both? Needed at all? Do they sterilize the skin or just act as a method to wipe away some of the grime?

more to follow.

'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )

Education is the anti-ignorance we all need to better treat our patients. ss, 2008.

The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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