DEPs: "Sucking" Chest Wound

[Dando175]

Goddammit Doc!! Where's my thesaurous? Wait a minute, isn't a thesauruos from the cretacious period?

Fucking medical terminology.

[Looon]

Goddammit Doc!! Where's my thesaurous? Wait a minute, isn't a thesauruos from the cretacious period?

Fucking medical terminology.

Sorry bro, couldn't wiggle out any more one syllable words without losing the content of the description.

Cretacious period...

Check Six,
Doc

I can't even remember how to spell 'TA-50' half the time

[Parabellum]

I would've used a damn tampon to plug the hole and let him breath with the good lung.

...and killed your Ranger buddy.

[Thursday]

An excellent peice of material that you can use to treat an open pnuemo is the celophane that comes on cigarettes. Usually, someone you are with will have a pack of smokes on them. Instruct them to take off the plastic on the bottom of it, cut it into a manageable peice that is larger that the open wound and tape it on 3 sides, leaving a 4th side open.

Leaving just one corner open will work, but if the pressure gradient is much higher inside the plueral space, then it will take longer for the lung to 'decompress'.

As for doing an actual lung decompression, you need to know some anatomical landmarks. Find the 2nd intercostal space mid clavicular like ( nipple line going in a vertical direction). Put your finger on the 3rd rib. Insert a 14 gage an giocathater that is 50mm in length just above the 3rd rib, practically scraping down the rib. Reason being is that the vein, artery and nerve all run directly under the rib. An easy way of remembering it is by saying the V.A.N. drives under the bridge, meaing, directly under the rib runs a vein, an artery and a nerve, in that order, from superior to inferior. You want to make sure that you dont hit any of those vessels.

There is also a second location that chest decompression can be adminsitered, which is the 5th intercostal space in the midaxillary line ( middle of the arm pit running vertically ), but this location is frowned upon by civillian EMS, except in certin circumstances.

Also, if you decompress someone with a needle, and air has ceased to rush out of the angiocath, or blood has started to leak from it, then use another needle, in the same intercostal space, just moving over laterally. If you have used several and you are running out of room, move to the 3rd intercostal space and decompress there.

Also, as for the spontaneous pnuemo, it is more common in white males in their teens and twenties that are very active and otherwise healthy. It can happen from something as easy as raising your arm over your head too quickly, followed by onset of difficulty breathing.


Doc, if anything needs fixing or if I am out of line, let me know and I'll fix the issue asap.

[Looon]

I would've used a damn tampon to plug the hole and let him breath with the good lung.

...and killed your Ranger buddy.

Yeah, haven't you ever heard of toxic shock syndrome...

The tampon is not a bad idea for other places, but with a hole in your chest, leading to your lungs, you want to have a set-up for the air to be able to be released and not reintroduced. That's what's so great about the Asherman Chest Seal. It does a remarkable job of covering the wound and providing a one way valve for air-release. Plus (and most beneficial for people like me) it's pretty monkey-proof. An opposible thumb and an IQ of 40 probably will get you the prerequisites for applying one.

Check Six,
Doc

I thought an 'asherman' was someone that smoked weed.

[MrsDocMac]

First I would remove all clothing from the area and try to clean up as much blood as possible from the skin. I would then cut a patch from any kind of non-permeable material such as poncho, bandage wrapper, or MRE wrapper. This patch needs to be at least 2 inches larger than the wound in both dimensions to prevent it from being pulled into the wound. I then use 100MPH tape to tape this patch over the wound, leaving one side untaped. This will allow air to exit the chest cavity. When the wounded man inhales, the patch sticks to the skin preventing air from re-entering the cavity.

If no tape is available, a battle dressing or cut up uniform could be used to secure the patch in place.

A battle dressing should be placed over the patch, but not too tight, as you want to allow air to escape from under the patch.

Doc, I gotta question here. It's been a while since CLS but I thought you weren't supposed to remove things such as clothing from wounds as they sometimes act as a dressing. Doesn't it cause more bleeding in some cases due to the fact that the blood may already be clotting and sticking to the clothing? Just curious....

[MrsDocMac]

Thanks Doc.

[PULSAR]

All you new Rippies better pay attention in the RFR class and out @ Cole Range, it will save your Ranger Buddy one day. If you come thru my trauma lane @ RIP you better know your shit