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EMS: Sucking Chest Wound

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Tue, 15 May 2012|

Mike McEvoy demonstrates new methods for dealing with a patient who has a sucking chest wound.

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Automatically Generated Transcript (may not be 100% accurate)

[MUSIC] Hi. Welcome to Training Minutes. Today I'm gonna talk about managing a patient with a sucking chest wound. So here, on this patient's anterior chest, we have a wound that's about the size of a nickel. Which in actuality, in order to cause collapse of a lung and a tension pneumothorax which is what's involved in a sucking chest wound. You need a hole that's at least a nickel sized hole. Holes that are smaller than that are not gonna have the effect of collapsing the lung and causing major hemodynamic compromise to a patient. Holes that are bigger than that are a much more difficult thing to manage. If this patient was shot, we'd be concerned about an exit wound. From our previous minutes, we had talked about a way that you could potentially seal a wound like this using an ECG electrode. And, while this is a reasonable approach as a way of covering up a wound like that, most of the sucking chest wounds that we actually see. Are gonna be much larger than that and a small ECG electrode is not gonna do the trick. We've learned in the past that a piece of petroleum gauze would actually be useful to seal a wound like that. The thought process being that you'd open the petroleum gauze, take this gauze itself. Which is occlusive, by nature of the fact that it's coated with petroleum, put that onto the wound and then cover the wound with a dressing. The dressing then would, in the past, have been sealed on three sides. So that we could actually allow air to escape from the collapsed lung and re-inflate the lung once we had a [UNKNOWN] dressing on the lung, or on the hole. So, currently the thought process has changed from covering the wound on three sides to completely covering the wound. And in fact, when you look at the most recent trauma literature, this process of attempting to put together. An occlusive dressing, using some petroleum gauze. Takes too long, and is too complicated to do. The military has for years used a device called an Asherman seal. The Asherman seal, very similar to what we had just seen, uses. A sterile gauze pad placed over the wound itself, and then the Asherman seal is a completely surrounding, occlusive dressing which is stuck onto the skin over the wound, and that allows the wound to breath through the small latex piece of. Attachment to the dressing itself. The Asherman seal is a difficult dressing to use in actual practice because it sweats off of most patients who have wounds of this size or the leakage from the wound bleeding would actually cause the dressing to. Come off the patient. Asherman seals are also very expensive, and because you'd go through many of them to try to treat a patient with a wound like this, we tend no longer to use an Asherman seal. So the new thought process for sealing a wound of this nature, is to use an expired AED electrode, and now we finally have a use for these electrodes that you've been throwing out for years. We take the AED electrode, place the electrode over the wound. Get rid of the wire going to the patient. Notice my pink scissors that you can buy so that people don't steal them from the ambulance. No one wants a pair of pink scissors. And now we have completely occluded the wound itself. If in fact the patient starts to have compromise from the lung collapsing underneath the sucking chest wound itself, what we would do is lift the dressing at one of the corners. And ask the patient to cough, or wait until he took a deep breath, and that would re-expand the lung underneath. For the present time though, we'll leave the dressing on the wound. Sealing all four sides of it, which is the current thinking in advanced trauma life support, pre hospital trauma life support, and all of the trauma literature. Take some sort of an writing implement and note on the a and d pad that you're covering a wound with it. Thanks for watching Training Minutes, I'm Mike McAvoy, [MUSIC] EMS [MUSIC] Here, a fire engineer.

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