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Old 05-09-2009, 17:09   #16
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Thanks

I just want to say thanks for allowing me on this site. I have been a member for about 5 months. By reading these posts I learn so much and it refreshes my memory. I don't get to use my "skills" often, and so far, thank God, haven't had to treat a gsw or knife wound to the chest.
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Old 05-14-2009, 16:43   #17
rcm_18d
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All that is out

The new generation of Asherman Chest seals have been sticking very well. I am sure there are some of the old ones still floating around though. The Rangers we taught last week said they have been having problems with the Hyfin dressings. They said after time the hydrogel or sticky stuff has been adhering to the package that the dressing comes in. They said the manufacture is changing the packaging to the tinfoil type like the old petroleum gauze. I have also heard that the MARSOC guys are not carrying the defib pads for chest dressings anymore due to the multitude of manufactures. The contract office never gets the right stuff especially if there are multiple options. There are some other reasons I just haven't gotten the whole story. If hydrogel didn't cost so damn much the answer would be easy! The bolin is what the Navy carries but I am not sold on it.
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Old 05-15-2009, 23:06   #18
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Cheap Hydrogel chest seal = PMI Halo seal
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Old 06-10-2009, 07:17   #19
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Chest Seals

My $.02: Not a QP, but I really like my job.
With the limited experience I have with the Bolin, I like it. The ACS is great if you have the time to make sure it sticks. The Hyfin sticks well and is more durable, but no one way valve. Need to get a hold of some bigger sizes. The survivability of the packaging varies. I have not had any Bolin fail yet when I test them after coming out of the bag, but I change my ACS out every 3 or 4 months because they get beat up and stick to their backing. Same problem with the Hyfin; one bag was exposed to some extreme heat though.
I've covered all open chest injuries because I was never in a very clean environment. Also, I have not learned any techniques to manage large holes in the chest without covering them or how to recognize the complications during monitoring other than the basics. Didn't feel comfortable with it. The first time I saw a lung, the only thing I could think about was covering it up, and getting them out of my house. While in Afghanistan I ran into some shrapnel injuries on locals by VBIED (3 MASCAL, and assorted other patients). It was never just one hole. I would use a combination of Hyfin and large Tagaderm with tape, and an ACS for the bigger holes that looked to be transferring air. If the wounds were bleeding in any troubling amount I used xeroform gauze and gauze pads over that, tape, sometimes an Israeli. I would worry about the NCD later. This was all in a small aid station setting. I had 7-10 great TCCC guys at a time and sometimes CANMIL medics. All the guys worked on these methods, and executed flawlessly. Another way I used the Asherman was on needle chest decompressions. I would place the ACS over the hub to secure it, and to provide a one way valve (someone told me this was not beneficial. True?) I know in a field setting it's not always an option, but all of these dressings worked if the surface was prepped. I ended up using disposable razors, tincture of benzoine, Dermabond and tape on a clean chest wall. They got to me 10-20 minutes after the explosion. I kept some for up to 12 hours. Couldn't always get them all out to KAF, some ended up making it to Pak in the back of trucks (thanks to a great Afghan Commander). The dressings worked while I had them, and I heard that the combinations of dressings worked on the way to the PAK hospitals.
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Old 06-12-2009, 22:23   #20
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Originally Posted by rcm_18d View Post
I agree that any cx wound is to be sealed, period!

I am merely an 18D(No Doc), and would like all the docs' perspective on when a cx tube should be performed in the field. My current thoughts on this, is when a needle decompression is a recurring event due to blood filling the pleural space and/or massive lung damage. Obviously the duration to further medical care is a huge one, but I understand this criteria. In the case of blood filling the space, I feel that it is a doubled edge sword. I feel it should be performed in conjunction with positive pressure ventilation to maintain some pressure on the lung to somewhat tamponade the bleeding. If it is a patient I will have to sit on for a while, the blood loss needs to be closely monitored, and blood is needed. This is one of the times for a rapid sequence induction, but that has it’s adverse effects as well. A cx tube alone could cause the loss of more blood than life can sustain. Once this sequence is begun the medic will most likely be tied to this patient for obvious reasons. A pleural vac will most likely not be available. Understand I have given chest tubes and I understand how quick and easy they are, but never in the field. Location is 5th ICS MAL. Any thoughts?
Much of this depends on the environment of the procedure, and how well you think you could preserve a sterile field. I don't think a sterile field is necessary in all situations. If you can do it, great. You'll have to balance the need for the chest tube against the risk of infection. The decision is more complex in the field than it is in the hospital due to the contamination issue that you bring up.

The short of it is, if you had to decompress them once, you will have to do it again. Therefore, the patient will require close monitoring no matter what, again tying up the provider to watch for reaccumulation of the tPTX. If the chest tube is in, then the PTX cannot build up under pressure to become a tension ptx. Even without a pleurevac, this applies.

If a patient is under positive pressure ventilation and you had to decompress, I would place a chest tube. A pleurevac is not really needed in this case, since the PPV will expand the lung sufficiently, and the CxT can be left open to air. This essentially creates an open PTX as SS discussed. A corollary: any patient on PPV with increasing vent pressures or difficulty bagging should be decompressed and have CxT placed.

For the patient in extremis, with impending cardiopulmonary arrest, I would place the chest tubes, even with no sterile equipment. Intubate them, place the tubes, and if you have neither the time nor the means to secure a drainage system, leave them open to air. If a chest tube is not immediately available, standard endotracheal tubes will suffice and can be placed in much the same manner as the CxT.

For a patient breathing on their own, a CxT without a flutter valve or pleurevac will essentially inactivate the affected lung, since the patient will not be able to create sufficient negative pressure in the chest to move enough air. This could potentially significantly increase the patient's work of breathing. If you recognize the need for a CxT in this setting and do not have the ability to manufacture an improvised pleurevac, then I would strongly consider intubating the patient for PPV.

Another consideration is if the patient with a simple PTX will undergo transport by air with significant altitude change, a CxT may be in order to prevent a simple PTX from becoming a tension PTX (although bringing them down in altitude makes this less likely than going up). The problem with air transport is that it is very difficult in that environment to auscultate for asymmetric lung sounds, so the flight medic/doc has to monitor other indications of tPTX. With our attention to hypothermia, stripping layers away from a patient to assess them is difficult and potentially hazardous to the patient. Worse yet, these indicators of PTX may go unnoticed. With a) a history of chest decompression, b) chest trauma, or c) respiratory difficulty after a blast injury, I would consider placement of a CxT prophylactically if transport will be longer than a few minutes.

If there is significant blood loss into the chest, and if you have a sterile drainage system with your chest tube, you may be able to autotransfuse the lost blood through a blood needle back into the patient. This is obviously more difficult through an improvised system, but still possible. And the patient's own blood cannot be improved upon as a resuscitation fluid.

I have never attended 18D training, so I don't know if any of the above is new information for anyone here. I'm not sure if this is what you were looking for, but I hope it helps.

'zilla
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Last edited by Doczilla; 06-12-2009 at 22:30. Reason: clarification
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Old 06-13-2009, 20:08   #21
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"Doczilla,"

I was wondering if you guys 'in the field' (FEBA-FOB-wherever) used THESE at all?

In at least one of the scenarios above I could see where this may be a great adjunctive therapeutic tool to have available for these instances.
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Old 10-21-2012, 20:35   #22
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HALO chest seals are just as good if not better than the hyfins, plus they come with two seals in a package
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Old 10-22-2012, 11:22   #23
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HALO makes a good seal, I like it...it does as advertised and sticks; you can repeatedly 'burp' it and it continues to stick. Good size and 2/pkg make it better. We got them for our SWAT team to carry with their TQ and combat gauze and all of the guys have been trained on its proper use. Doesn't take a rocket scientist (or neurosurgeon) to be able to use one correctly and did I mention they stick to a bloody chest wall.......

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Old 05-13-2014, 12:53   #24
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Now that a vented seal is the first choice dressing per TCCC, which brand of chest seal products are you guys seeing and/or recommend: SAM, HALO, HyFin, etc? In my research I have read that the current crop of vented seals are all acceptably effective regarding venting, but their adhesion in tough environments varies.

Last edited by LeakyBandage; 05-13-2014 at 12:55.
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Old 05-13-2014, 16:16   #25
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Originally Posted by Brush Okie View Post
Duct tape and a plastic MRE bag work very well. It is the skill of the person more than the bandage its self. The problem with ANYTHING sticking is the person many times is covered in blood and or sweat from shock. you can dry them off then use the little ampules of sticky skin prep stuff for using steri strips. (cant remember name)
Tincture of Benzoin.

Burns like a MF when injected into a blister.

TR
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Old 05-15-2014, 07:14   #26
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Originally Posted by The Reaper
Tincture of Benzoin.

Burns like a MF when injected into a blister.

TR
Is that an effective treatment for a blister, or is it simply cheap entertainment?
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Old 12-02-2014, 20:01   #27
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Breacher's Tape

The aid station I was at for a while kept a roll of "breacher's tape" to use for chest seals. Thankfully while I was there we never had to use it, but the SF medics swore that it was the best chest seal ever made. Supposedly it would almost remove skin when it was removed but it would stick to anything wet as it was designed to be able to attach explosives underwater, hold them on doors, etc. As I recall, it was about 12in wide and several feet long of the stickiest plastic tape I have ever messed with in my life. I was just a support 68W but supposedly it works very well.
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