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Old 03-15-2009, 12:37   #1
crash
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Question Prefered chest seal

We currently use the Asheman chest seal, which I've never been a fan of.

What have your expericens been with the below products, which do you prefer?


W/ One way valves
Bolin Chest Seal NSN: 6510-01-549-0939
Asherman Chest Seal NSN: 6510-01-408-1920
Emergency Chest Seal (tqsresponce .com)

W/O one way valve
Wound Seal NSN: 6510-01-562-3346
Hyfin Chest Seal NSN: 6515-01-532-8019
H and H Wound Seal NSN: 6510-01-562-3346

Are their others? (other than field expediant)

In my experience the ashermans have been flimsy and never want to stick to anything. Played with a Bolin awhile back and liked it, we've ordered a few to test out.

Have not used the wound seal; but have used the Hyfin seals and was impressed with their stickyness.
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Old 03-15-2009, 12:50   #2
Surgicalcric
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I like the Hyphin seals for their adhesiveness and the Bolin is in second place. Never really cared for the ACS. It is a good concept but the adhesive just doesnt cut the mustard.

Defib pads work great too...
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Old 03-15-2009, 13:09   #3
swatsurgeon
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time to throw a wrench into the mix:

What is the indication to apply a chest seal....BE SPECIFIC, and back up your answer with an explanation. (Time we all learn some facts rather than fiction)

ss
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Old 03-16-2009, 13:23   #4
rcm_18d
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Indication

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.
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Old 03-29-2009, 11:07   #5
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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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(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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Old 03-30-2009, 09:20   #6
rcm_18d
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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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Old 03-16-2009, 16:06   #7
crash
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Quote:
Originally Posted by Surgicalcric View Post
I like the Hyphin seals for their adhesiveness and the Bolin is in second place. Never really cared for the ACS. It is a good concept but the adhesive just doesnt cut the mustard.

Defib pads work great too...
Never thought about defib pads before, seems like it would work; don't usually have propaqs or the pads in the field.
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Old 03-28-2009, 21:22   #8
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I concur. Nice answer and we (18Ds/and or those taught) would be prepared for needle D which as now in TCCC requires two indications. MOI and difficulty breathing.
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