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Old 03-29-2009, 11:07   #7
swatsurgeon
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Location: Phoenix, AZ
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Quote:
Originally Posted by rcm_18d View Post
The indications for a chest seal is any penetrating wound from the clavicles’ to the belly button on any of the four sides of the chest (front, back, and armpits). This is conducted after Situation(winning the fight), Major bleeding, and Airway are addressed. This would be considered a chest wound because it is never clear where the patient was in his or her respiratory drive when the injury occurred. The intent is to stop any air going into the pleural space from the outside. The purpose of the three sided dressings (i.e. Asherman, Bolin, or Emergency Chest Seal by Asherman) is to allow air to escape if it can, to prevent the development of a Tension Pneumothorax. This is the second leading cause of preventable death on the battlefield.
Any penetrating wound....interesting. If there is free communication, lets say a hole the size of a silver dollar so that the lung is visible, is there a risk to an "open PTX"? What is the risk?
As far as air getting in and causing a tension PTX, there must be a way to trap the air in the chest cavity (refer to my first question). What is the scientific validity to a 3 way chest seal, has it been proven to be necessary on all chest wounds regardless of etiology, size, mechanism, patient status????

ss
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'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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