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Old 03-30-2009, 09:20   #8
rcm_18d
Quiet Professional
 
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Join Date: Jan 2009
Location: Ocean Springs, MS
Posts: 38
Cx wound

I see your point, “why seal a wound that is relieving itself.”

At the same time will a three sided dressing cause any further harm if emplaced correctly? If there is a path of least resistance scenario, air is entering faster than it is escaping, the absence of a dressing could potentially cause the lung to collapse faster than it would if it was treated. The lung may not be completely collapsed at the time of the treatment and could potentially have some remaining surface tension that allows some air exchange. This, in my opinion, is the reason it is universal to seal the chest from the outside with a one way valve. I personally feel that there is nothing wrong at all with sealing the cx completely, from a medic stance, but I carry many needles for decompression. The problem arises if the care is passed to another due to the tactical situation. The recognition of true, progressive shortness of breath, or difficulty breathing can be difficult to the untrained operator. We conduct an exercise for our students where they, carry a straw, and run 100m or so, as fast as they can, at the end of the run they plug their nose, breath through the straw, and look at their buddy. We try to explain that this is how a patient with difficulty breathing will present. The three sided dressings are the dressing of choice for the lowest common denominator. Most of the time the first responder will not be a medic and it is the KISS (Keep It Simple Stupid) principle that calls for one dressing to treat any penetrating cx wound. I personally carry patches of HydroGel and really like the Hyfin. Defib pads are good as well but the difference in manufactures can very the effectiveness. The development of tension normally takes some time and a needle decompression is very fast, easy, and effective. What are your thoughts on a cx tube for extreme circumstances?
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