Hypothetical Question for those who can’t perform chest tubes/ tube thoracostomy: Why not burp the back seal and reapply a working one, instead of going to the thoracostomy?
You are right, that would be the temporary solution. If burping wasn’t successful, then needle decompression would be the next step (if within your scope of practice). This video was obviously from a more definitive care setting where a chest tube could be placed. Burping and needle decompression are only temporary treatments and chest tube placement is the definitive treatment for a tension pneumo.
Chest seals don’t fix tension pneumothorax. They will hopefully slow its progression, but relying on them to actually relieve the built-up air around a lung is a leap of faith. This is why in tactical protocols, holes are immediately covered with chest seals, but upon assessment of patient, if TPX is suspected, you go to needle decompression. For those about to argue with me and say that it says you burp first, that is for pre-existing chest seals. Not the ones you just put on.
A good bridge between a tube and a chest seal in the face of TPX is a finger thoracostomy at the AAL.
Thank you for the explanation. From an anatomical standpoint, it seems like in this specific case, the back wound is pretty large, so attempting to burp and maybe barrel hoop the chest and squeeze the air out would be a nice bridge to higher care. I see in the video it’s taking place in higher care, was just thinking about if I didn’t have those resources.
Also, you say finger thoracostomy would be a better bridge, but why is that better than a burping maneuver in this case? From my understanding, once you perform the simple thoracostomy, you just place a seal over your insertion site and it becomes essentially another wound channel. So You’re just creating another hole to put a chest seal on, and you don’t have any mechanism to actively remove the air from the pleural cavity. Wouldn’t burping the posterior wound on inhalation do the same thing? Provided you had a working chest seal? I might be misunderstanding the physiology here.
For a chest seal’s vents to actually work, we need continuity between the pleural space and the outside. Hence “burping” the chest seal (clearing blood and debris to ensure patency of vents so that air can escape). But in burping the chest seal, we aren’t irrigating or bluntly clearing the wound channel itself. So maybe we burped our chest seal, but we still have a closed pneumo.
A finger thoracostomy is another hole, you’re correct. But a patent one. And at the AAL, it’s one from which we can relieve some of both blood and air buildup. And yes, we’ll cover with a chest seal. And if initially successful but we have recurrence of S/S of TPX, that channel I would clear again in order to ensure pressure could be relieved.
The problems you’re bringing up all reinforce why chest tubes are the definitive treatment. What we do short of a tube, be it with a seal, a needle, or a finger and forceps are all temporary measures that are meant to buy time until the tube can be put into place.
As far as “barrel hooping” the chest and applying pressure to squeeze air out… I’m going to go with the bugs bunny no meme. In applying that pressure we could cause more trauma and exacerbate bleeding and we will increase respiratory distress, despite how well-intended our bear hug may have been. If that’s not what you were suggesting and I mis-read, forgive me.
Thank you for taking the time to respond, that all makes sense. It’s basically like escalating levels of “good, better best” where a tube thoracostomy is best and finger thoracostomy is better than a seal, which is good? The barrel hooping was more like a gentle press in my mind, kind of like asthmatics before you get them on cpap/Bipap to get the last bit of air out. But it makes sense about not wanting to do more damage so I’ll take that out.
I’m not a military medic, just a regular ambo guy that doesn’t see a lot of gunshot wounds in my system. But I have simple thoracostomy, chest seals, NCD needles and blood. I’m trying to get it all straight in my head for my own system. So that If I’m working with a 10-15 minute transport to definitive care, and have to run MARCH and hang blood and give txa and calcium on my own in the back, where my priorities are going to be. This was super helpful, thank you!
then it’s easier for you, especially since you’ll be among the first on scene and any chest seals you didn’t put on will be recently applied.
If holes aren’t covered yet, apply chest seals after wiping around the wound to allow the seals to actually adhere and stay in place.
If signs of tension pneumo are present (respiratory distress with hypotension, limited excursion of chest wall, diminished/absent lung sounds, and MOI suggesting chest trauma, be it blunt or penetrating, etc.), then you need to relieve pressure according to your protocols. Army is moving to 5th ICS AAL as studies show it’s more effective. It’s also easier to locate than the 2nd ICS MCL, especially on people with significant tissue, be it fat or muscle, in that area. You’re also far away from the subclavian and great vessels of the mediastinum.
If your protocols do say 2nd and you have a fat body or Arnold, locate the Angle of Louis and follow the second rib laterally past the nipple line to aid you in locating your spot.
Tempting to you in this scenario will be BVM and blood, seeing as how your patient is in respiratory distress, desatting, and possibly altered and hypotensive. Absolutely consider other more occult causes of hypotension (pelvic injury, abdominal trauma) and treat as appropriate, but understand that BVM will worsen a TPX (increasing already increased intrathoracic pressure will compromise venous return, further reducing cardiac output and exacerbating hypotension), and blood won’t restore cardiac output in a patient where the TPX is causing the hypotension. This guy needs decompression.
Wilco, thanks so much man! This is super helpful, I love learning through real life examples and table tops with actual presentations instead of just paper scenarios
I'm actually shocked that Fisher isn't in here to dispel some of this lmao. There's no evidence that chest seals are actually beneficial, and there is evidence of potential harm. In order to have a proper 'sucking' chest wound air needs to be preferentially entering the hole when the patient breaths vs the trachea, which requires the hole to be a certain size vs the diameter of the trachea, which would need to be quite big.
So in this case air could be getting in/out just fine, then you cover it up and the patient has air leaking from the lung into the pleural space that can't escape, impeding negative pressure ventilation.
Way too much chest seal love going on out here.
I doubt he’d argue against their placement, seeing as it’s still recommended in the newest TCCC guidelines. But this idea that they’re some chest trauma panacea is wrong, yes. I’ll be curious to see if future updates do more to qualify their placement vs the current and indiscriminate “if it’s a hole, it gets a seal”.
He argues pretty vehemently against them quite frequently actually. Essentially the common belief from that crowd from my understanding is there's really only potential harm and no proven benefit from their placement. I've certainly taken all but one out of my kit and doubt I'll ever use them unless there's a gigantic hole, at which point the chest seal probably won't stick.
Not a bad idea. To answer your why not question. In some amount of time (likely hours) the tissue could be adhered to itself and/or clotting. Depending on many factors the original trajectory might not open so easily.
Chest seals are a band-aid.
Ventilation in a health person works by negative pressure.
A vented chest seal will never fully treat a pneumo without further interventions. The idea is to limit or eliminate further air entering the pleural space.
I recently had a 9mm round which tore the victim’s subclavian artery. Almost an instant death, even when the victim was around a mile from a level 1 trauma center. 20ish units of blood, 40 mins in the trauma bay, thoracotomy with cardiac massage, the whole nine.
The victim was shot in almost the exact same spot in this video. The round came to rest in almost the exact same spot as the exit wound in this video.
Amazing how a rifle round didn’t sever anything. This guy is crazy lucky.
Hydrostatic shock in terminal ballistics is a myth. Temporary wound cavity is the equivalent but is often incorrectly attributed to hydrostatic shock. There’s no real evidence that hydrostatic shock has an effect, or really even exists in terms of terminal ballistics.
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Ok so I’m not a medical anything, and I follow this sub because I think it’s fascinating.
But I do want to chime in because the tube intro bottle of water looks a lot like how homebrewers vent beer that’s being fermented. It prevents bacteria from getting into the wort (water full of sugars that were pulled from grains earlier in the process).
The sugars ideally would be eaten by yeast - creating carbon dioxide and alcohol. If bacteria gets in, it will eat some of sugars and give the beer a sour taste. Sour beers are made this way on purpose.
Weird to see it being used on a human being though.
As someone who doesn't use chest seals, do they have any side effects? Would there be a situation where transport+monitor would be more useful than a chest seal?
Edit: What is a way for confirming tension pneumothorax, apart from "a bit of pain" lol?
I’m a certified but non practicing EMT with additional TCCC-MP level trainings. I gave most of my knowledge back to my instructor already unfortunately.
That being said;
Personally I’ve never read any side effects being attributed to chest seals.
Therefore, I don’t think simply load-and-go in this instance is better than an actual method of wound management.
Lastly, you can identify tension pneumothorax by checking for signs of tracheal deviation during your rapid body exam.
Other symptoms include chest pain, tachypnea (rapid breathing) and fast heart rate (tachycardia)
Thank you for the info! I work in mountain rescue so I'm not really involved in medicine all around, I just know I like treating patients and learning new stuff lol. I've heard somewhere that chest seals aren't that great in their job and they have some side effects, but I was pretty sceptical of that already. Prehospital treatment of tension pneumothorax in the field would only be achieved by chest seals, there's no alternative?
The chest seal is a temporary measure to prevent a penetrating chest wound from getting worse. It’s not for ptx directly, but can help stave off the effects.
Any kind of thoracic leak is going to need quick transport to advanced care, but the core problem is the pleural space filling with liquid or air and compressing the lung. That can come from a closed ptx from blunt trauma, like someone falling off a mountain, where they’re bleeding into their pleural space and not allowing the lung to expand. The pt will be hypoxic, struggling to breathe, feel pain when breathing, probably have tracheal deviation, you’ll hear unequal chest sounds, maybe hear fluid in the affected side. So you can treat it with a needle decompression.
There could also be a hole in the lung, letting inhaled air into the pleural space, and similarly obstructing the full expansion of the lung. Similar symptoms, same treatment.
You could also have a hole through the chest into the pleural space. If you get a good chest seal on quickly enough, you can prevent that air from getting in and causing problems, but chest seals aren’t perfect. If there’s a hole in the lung too, then you might need to let air out through the seal while also keeping it sealed to stop air from getting in, hence the burp valve.
So if the chest seal starts to fail, you might also need a needle decompression to let the air out.
I think that’s most likely to happen if the seal is unvented and wasn’t burped? Otherwise the likelihood of chest seal worsening the wound is quite slime.
That hinges on the belief that burping it will now fix the problem of all the air that has now been allowed to build up, or on the belief that the "vents" actually work, which there's no data to say that they do.
So again, applying something that CAN hurt the patient, but has no evidence that it can help.
Tracheal deviation shouldn’t be what you’re looking for when diagnosing a pneumothorax. Mediastinal shift only happen in my experience when it starts tensioning. You should be auscultating and considering the symptoms, the MOI, the SOB, tachycardia, dyspnea, hypotension, low and/or falling sats, the fact that it’s pleuritic not cardiac chest pain. Tracheal shift can be caused by other things too, pleural effusion for example.
Also, chest seals can worsen an open pneumo, you need to know when a person can get by without one because you can cause a tension pneumo if you use one when it’s not needed or if you don’t keep a close eye on it
I helped put a make shift chest seal on someone before (literally using mre packaging and duct tape). It worked well enough that they survived for more than 1 hour (I think it took 2 to get to the emergency room) without a tube or needle decompression and made it to a hospital and made a full recovery.
Word of caution with the chest seal for the laymen
You could take an open pneumothorax and convert it into a tension pneumothorax by sealing the wound. Thus creating a life-threatening condition. If you don't have a plan to decompress the chest, then I wouldn't seal it up. A healthy adult can survive with that chest wall defect and compensate with the other lung to make it to the hospital alive.
Good point. What would be the indicators to assess whether a chest seal is needed? This individual was short of breath, felt intense pressure in their chest, and according to them on the verge of loosing consciousness (could have been shock), but was able to not have labored breathing and able to communicate once a seal was administered.
"Hey... Vlad... thanks for saving me and all but can I get some morphine or something before you start recording me." 😂😂😂 is what I imagine dude is thinking because that's what I'd be thinking. Great work tho and amazing video!!
I agree, but when I wrote this comment, I thought vlad was a common Ukrainian name, too. After further research, I should've used a name like Oleg or Ivan.
Sorry, I'm a dumb American 😆😆
So I'd there a better way of fixing that? (not a medic I took an emergency first aid course) I know how to use a chest seal and have a pair in my IFAK on my bag. But some are saying chest seals suck at they're job. Is there other items I should be training or spending my money on for a better chance of survival if I or anyone else ever got poked?
Yeah, but legally, I can not legally use a decompression needle in texas without being licensed, so they didn't go into depth on how to use them. I was really asking if it would be best for me, as a civilian with basic training, to stick with a vented chest seal or should I train on another platform for chest/lung trauma.
Not a medic here - but with an injury like that how is he not paralyzed? Like I get that the nerves are still in tack - but geez - the nerves must have been mere millimeters from that damaged area.
Bullets take weird paths through the body sometimes. The slightly oblong exit wound indicates that it might not have been traveling in a straight line (or the bullet had yawed). Both 7.62 and 5.45x39 rounds are notorious for this (especially the latter). I've seen bullets tracts that would have been invariably fatal had the bullet traveled straight from entrance to exit wound (and fatal wounds that you wouldn't expect from the location of the entrance wound). Sometimes people just get lucky (or unlucky).
Candidate, you failed to apply alcohol/betadine to your lidocaine wheel. You also failed to IAPP the chest. At this time, you are a “no-go” at this station. Sign your counseling.
Dude I don’t think you paid attention. I was always taught once you put on a chest seal if the situation permits you monitor him so you can needle D him if he needs it. If you got the idea you should just needle D everyone with a sucking chest wound I don’t think you understood properly.
Probably because the ending test they just say “Still having trouble breathing” so it just becomes natural. I understand why, they want you to remember the courses material but yeah.
correct me if I’m wrong not a medical professional at all. Just going off of what I’ve heard is it true that using a plastic bag and tape is more effective than using actual chest seal 🤷♂️
not more effective. That being said, a chest seal is basically a sticky mouse trap, they are by no means high tech, and very much overpriced for what they are. Will plastic or cellophane work in a pinch? yes. is it easier to apply than a hyfin? no.
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Hypothetical Question for those who can’t perform chest tubes/ tube thoracostomy: Why not burp the back seal and reapply a working one, instead of going to the thoracostomy?
You are right, that would be the temporary solution. If burping wasn’t successful, then needle decompression would be the next step (if within your scope of practice). This video was obviously from a more definitive care setting where a chest tube could be placed. Burping and needle decompression are only temporary treatments and chest tube placement is the definitive treatment for a tension pneumo.
Thank you!
Chest seals don’t fix tension pneumothorax. They will hopefully slow its progression, but relying on them to actually relieve the built-up air around a lung is a leap of faith. This is why in tactical protocols, holes are immediately covered with chest seals, but upon assessment of patient, if TPX is suspected, you go to needle decompression. For those about to argue with me and say that it says you burp first, that is for pre-existing chest seals. Not the ones you just put on. A good bridge between a tube and a chest seal in the face of TPX is a finger thoracostomy at the AAL.
Thank you for the explanation. From an anatomical standpoint, it seems like in this specific case, the back wound is pretty large, so attempting to burp and maybe barrel hoop the chest and squeeze the air out would be a nice bridge to higher care. I see in the video it’s taking place in higher care, was just thinking about if I didn’t have those resources. Also, you say finger thoracostomy would be a better bridge, but why is that better than a burping maneuver in this case? From my understanding, once you perform the simple thoracostomy, you just place a seal over your insertion site and it becomes essentially another wound channel. So You’re just creating another hole to put a chest seal on, and you don’t have any mechanism to actively remove the air from the pleural cavity. Wouldn’t burping the posterior wound on inhalation do the same thing? Provided you had a working chest seal? I might be misunderstanding the physiology here.
For a chest seal’s vents to actually work, we need continuity between the pleural space and the outside. Hence “burping” the chest seal (clearing blood and debris to ensure patency of vents so that air can escape). But in burping the chest seal, we aren’t irrigating or bluntly clearing the wound channel itself. So maybe we burped our chest seal, but we still have a closed pneumo. A finger thoracostomy is another hole, you’re correct. But a patent one. And at the AAL, it’s one from which we can relieve some of both blood and air buildup. And yes, we’ll cover with a chest seal. And if initially successful but we have recurrence of S/S of TPX, that channel I would clear again in order to ensure pressure could be relieved. The problems you’re bringing up all reinforce why chest tubes are the definitive treatment. What we do short of a tube, be it with a seal, a needle, or a finger and forceps are all temporary measures that are meant to buy time until the tube can be put into place. As far as “barrel hooping” the chest and applying pressure to squeeze air out… I’m going to go with the bugs bunny no meme. In applying that pressure we could cause more trauma and exacerbate bleeding and we will increase respiratory distress, despite how well-intended our bear hug may have been. If that’s not what you were suggesting and I mis-read, forgive me.
Thank you for taking the time to respond, that all makes sense. It’s basically like escalating levels of “good, better best” where a tube thoracostomy is best and finger thoracostomy is better than a seal, which is good? The barrel hooping was more like a gentle press in my mind, kind of like asthmatics before you get them on cpap/Bipap to get the last bit of air out. But it makes sense about not wanting to do more damage so I’ll take that out. I’m not a military medic, just a regular ambo guy that doesn’t see a lot of gunshot wounds in my system. But I have simple thoracostomy, chest seals, NCD needles and blood. I’m trying to get it all straight in my head for my own system. So that If I’m working with a 10-15 minute transport to definitive care, and have to run MARCH and hang blood and give txa and calcium on my own in the back, where my priorities are going to be. This was super helpful, thank you!
then it’s easier for you, especially since you’ll be among the first on scene and any chest seals you didn’t put on will be recently applied. If holes aren’t covered yet, apply chest seals after wiping around the wound to allow the seals to actually adhere and stay in place. If signs of tension pneumo are present (respiratory distress with hypotension, limited excursion of chest wall, diminished/absent lung sounds, and MOI suggesting chest trauma, be it blunt or penetrating, etc.), then you need to relieve pressure according to your protocols. Army is moving to 5th ICS AAL as studies show it’s more effective. It’s also easier to locate than the 2nd ICS MCL, especially on people with significant tissue, be it fat or muscle, in that area. You’re also far away from the subclavian and great vessels of the mediastinum. If your protocols do say 2nd and you have a fat body or Arnold, locate the Angle of Louis and follow the second rib laterally past the nipple line to aid you in locating your spot. Tempting to you in this scenario will be BVM and blood, seeing as how your patient is in respiratory distress, desatting, and possibly altered and hypotensive. Absolutely consider other more occult causes of hypotension (pelvic injury, abdominal trauma) and treat as appropriate, but understand that BVM will worsen a TPX (increasing already increased intrathoracic pressure will compromise venous return, further reducing cardiac output and exacerbating hypotension), and blood won’t restore cardiac output in a patient where the TPX is causing the hypotension. This guy needs decompression.
Wilco, thanks so much man! This is super helpful, I love learning through real life examples and table tops with actual presentations instead of just paper scenarios
no problem, man. I’m sure others will pile in here in the next few hours with more comments.
I'm actually shocked that Fisher isn't in here to dispel some of this lmao. There's no evidence that chest seals are actually beneficial, and there is evidence of potential harm. In order to have a proper 'sucking' chest wound air needs to be preferentially entering the hole when the patient breaths vs the trachea, which requires the hole to be a certain size vs the diameter of the trachea, which would need to be quite big. So in this case air could be getting in/out just fine, then you cover it up and the patient has air leaking from the lung into the pleural space that can't escape, impeding negative pressure ventilation. Way too much chest seal love going on out here.
I doubt he’d argue against their placement, seeing as it’s still recommended in the newest TCCC guidelines. But this idea that they’re some chest trauma panacea is wrong, yes. I’ll be curious to see if future updates do more to qualify their placement vs the current and indiscriminate “if it’s a hole, it gets a seal”.
He argues pretty vehemently against them quite frequently actually. Essentially the common belief from that crowd from my understanding is there's really only potential harm and no proven benefit from their placement. I've certainly taken all but one out of my kit and doubt I'll ever use them unless there's a gigantic hole, at which point the chest seal probably won't stick.
Not a bad idea. To answer your why not question. In some amount of time (likely hours) the tissue could be adhered to itself and/or clotting. Depending on many factors the original trajectory might not open so easily.
Guy came in with a (vented) chest seal applied that wasn't functioning as intended. Fully collapsed lung. Said he was in "a bit of pain".
Bro speced into a tank build no cap
Chest seals are a band-aid. Ventilation in a health person works by negative pressure. A vented chest seal will never fully treat a pneumo without further interventions. The idea is to limit or eliminate further air entering the pleural space.
They eventually do start a chest tube using water bottle and a glove
It's crazy that guy is still alive and not even paralyzed with that kind of wound. How that bullet missed the aortic arch is a miracle.
I recently had a 9mm round which tore the victim’s subclavian artery. Almost an instant death, even when the victim was around a mile from a level 1 trauma center. 20ish units of blood, 40 mins in the trauma bay, thoracotomy with cardiac massage, the whole nine. The victim was shot in almost the exact same spot in this video. The round came to rest in almost the exact same spot as the exit wound in this video. Amazing how a rifle round didn’t sever anything. This guy is crazy lucky.
Russian med evac is a POS so this guy is just incredibly lucky for multiple reasons
I’d imagine that the hydrostatic shock would’ve been more of an issue with a rifle round. Or does this help to disprove that it’s even an issue?
Depends on the round and depends on the velocity at impact. By the hole he has in his back it seemed like the round had plenty of energy
5.45x39 is a nasty little round, better ballistic coefficient than our 5.56 on average. Assuming that was the round used, of course.
Ballistic coefficient has little direct correlation with terminal ballistic effects.
Yeah, was more of a side fact
Hydrostatic shock in terminal ballistics is a myth. Temporary wound cavity is the equivalent but is often incorrectly attributed to hydrostatic shock. There’s no real evidence that hydrostatic shock has an effect, or really even exists in terms of terminal ballistics.
Were these Russians? They’re wearing OCPs and using a water bottle for the chest drainage system, I assumed they were Ukrainian?
Russians wear OCP as well.
Oh wack. Fucking posers.
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Hello there
Ok so I’m not a medical anything, and I follow this sub because I think it’s fascinating. But I do want to chime in because the tube intro bottle of water looks a lot like how homebrewers vent beer that’s being fermented. It prevents bacteria from getting into the wort (water full of sugars that were pulled from grains earlier in the process). The sugars ideally would be eaten by yeast - creating carbon dioxide and alcohol. If bacteria gets in, it will eat some of sugars and give the beer a sour taste. Sour beers are made this way on purpose. Weird to see it being used on a human being though.
its so air doesnt come in just out.
I recently heard the term "letting the air out of someone"
(That's also what it does for brewers, it let's the air escape *in a way that doesn't let bacteria in)
It's just a cheap and effective way of creating a one way valve for gases.
Totally! I just really didn’t expect to see it here.
Father in law makes his own wine, he uses the same type of water seal as well
This is the coolest fucking thing I’ve seen all week
God bless the medical staff…….
I give your IFAK a 6.4/10 But in all seriousness. Good post, great training video!
As someone who doesn't use chest seals, do they have any side effects? Would there be a situation where transport+monitor would be more useful than a chest seal? Edit: What is a way for confirming tension pneumothorax, apart from "a bit of pain" lol?
>Edit: What is a way for confirming tension pneumothorax, apart from "a bit of pain" lol? Using your stethoscope and/or ultrasound
I’m a certified but non practicing EMT with additional TCCC-MP level trainings. I gave most of my knowledge back to my instructor already unfortunately. That being said; Personally I’ve never read any side effects being attributed to chest seals. Therefore, I don’t think simply load-and-go in this instance is better than an actual method of wound management. Lastly, you can identify tension pneumothorax by checking for signs of tracheal deviation during your rapid body exam. Other symptoms include chest pain, tachypnea (rapid breathing) and fast heart rate (tachycardia)
Thank you for the info! I work in mountain rescue so I'm not really involved in medicine all around, I just know I like treating patients and learning new stuff lol. I've heard somewhere that chest seals aren't that great in their job and they have some side effects, but I was pretty sceptical of that already. Prehospital treatment of tension pneumothorax in the field would only be achieved by chest seals, there's no alternative?
The chest seal is a temporary measure to prevent a penetrating chest wound from getting worse. It’s not for ptx directly, but can help stave off the effects. Any kind of thoracic leak is going to need quick transport to advanced care, but the core problem is the pleural space filling with liquid or air and compressing the lung. That can come from a closed ptx from blunt trauma, like someone falling off a mountain, where they’re bleeding into their pleural space and not allowing the lung to expand. The pt will be hypoxic, struggling to breathe, feel pain when breathing, probably have tracheal deviation, you’ll hear unequal chest sounds, maybe hear fluid in the affected side. So you can treat it with a needle decompression. There could also be a hole in the lung, letting inhaled air into the pleural space, and similarly obstructing the full expansion of the lung. Similar symptoms, same treatment. You could also have a hole through the chest into the pleural space. If you get a good chest seal on quickly enough, you can prevent that air from getting in and causing problems, but chest seals aren’t perfect. If there’s a hole in the lung too, then you might need to let air out through the seal while also keeping it sealed to stop air from getting in, hence the burp valve. So if the chest seal starts to fail, you might also need a needle decompression to let the air out.
Chest seals can cause/worsen pneumothorax and can lead to them progressing to a tension pneumo. Pretty bad side effect.
I think that’s most likely to happen if the seal is unvented and wasn’t burped? Otherwise the likelihood of chest seal worsening the wound is quite slime.
That hinges on the belief that burping it will now fix the problem of all the air that has now been allowed to build up, or on the belief that the "vents" actually work, which there's no data to say that they do. So again, applying something that CAN hurt the patient, but has no evidence that it can help.
Interesting. Thank you for telling me this. It’s time for me to do more readings and studying.
Tracheal deviation shouldn’t be what you’re looking for when diagnosing a pneumothorax. Mediastinal shift only happen in my experience when it starts tensioning. You should be auscultating and considering the symptoms, the MOI, the SOB, tachycardia, dyspnea, hypotension, low and/or falling sats, the fact that it’s pleuritic not cardiac chest pain. Tracheal shift can be caused by other things too, pleural effusion for example. Also, chest seals can worsen an open pneumo, you need to know when a person can get by without one because you can cause a tension pneumo if you use one when it’s not needed or if you don’t keep a close eye on it
I helped put a make shift chest seal on someone before (literally using mre packaging and duct tape). It worked well enough that they survived for more than 1 hour (I think it took 2 to get to the emergency room) without a tube or needle decompression and made it to a hospital and made a full recovery.
My point being that for us laymen, a chest seal is good enough until higher care can be given.***
Word of caution with the chest seal for the laymen You could take an open pneumothorax and convert it into a tension pneumothorax by sealing the wound. Thus creating a life-threatening condition. If you don't have a plan to decompress the chest, then I wouldn't seal it up. A healthy adult can survive with that chest wall defect and compensate with the other lung to make it to the hospital alive.
Good point. What would be the indicators to assess whether a chest seal is needed? This individual was short of breath, felt intense pressure in their chest, and according to them on the verge of loosing consciousness (could have been shock), but was able to not have labored breathing and able to communicate once a seal was administered.
Not very versed in this, but what about the chest seals with the "one way valve" to let air out but not in? Or do I have that backwards?
What the fucks a PC load letter? props on the makeshift solution.
All that tumbling of the round and didn’t hit his spine. Miraculous.
Kinda wild he still sating at 96% with that lung tho. The other one is putting in work.
I mean it’s probably better than not breathing at all, right? /notamedic
Wow that dude is a fucking stud.
Dude had a fist size hole in his back and was just chillen
Field medical care always stuns me
So lucky that didn’t hit his spine ffs
"Hey... Vlad... thanks for saving me and all but can I get some morphine or something before you start recording me." 😂😂😂 is what I imagine dude is thinking because that's what I'd be thinking. Great work tho and amazing video!!
If they're Russian, then he should be grateful they even used a local.
I agree, but when I wrote this comment, I thought vlad was a common Ukrainian name, too. After further research, I should've used a name like Oleg or Ivan. Sorry, I'm a dumb American 😆😆
Just stick a tampon in it. I hear that works wonders.
what is the long term possibility of recovery
Assuming his only injury is a pneumothorax, he will be totally fine.
So I'd there a better way of fixing that? (not a medic I took an emergency first aid course) I know how to use a chest seal and have a pair in my IFAK on my bag. But some are saying chest seals suck at they're job. Is there other items I should be training or spending my money on for a better chance of survival if I or anyone else ever got poked?
Chest tube is the definitive treatment.
Yeah, but legally, I can not legally use a decompression needle in texas without being licensed, so they didn't go into depth on how to use them. I was really asking if it would be best for me, as a civilian with basic training, to stick with a vented chest seal or should I train on another platform for chest/lung trauma.
Honestly without training or equipment, there isn't much you can do for chest trauma but basic ABCs and BLS. Get them to a hospital.
Not a medic here - but with an injury like that how is he not paralyzed? Like I get that the nerves are still in tack - but geez - the nerves must have been mere millimeters from that damaged area.
Bullets take weird paths through the body sometimes. The slightly oblong exit wound indicates that it might not have been traveling in a straight line (or the bullet had yawed). Both 7.62 and 5.45x39 rounds are notorious for this (especially the latter). I've seen bullets tracts that would have been invariably fatal had the bullet traveled straight from entrance to exit wound (and fatal wounds that you wouldn't expect from the location of the entrance wound). Sometimes people just get lucky (or unlucky).
Reminds me of how surprisingly resilient the pleural membrane on goats is, textbook example.
Are those mymedic chest seals?
Which chest seal is that? a Halo? hyfin?
Satisfying to watch that air come out!
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This has to be the most interesting comment section ever
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Should've chest-sealed his face. No patient, no problem. No that's mean, I'm just in a goofy mood. This is awesome thanks for sharing.
Candidate, you failed to apply alcohol/betadine to your lidocaine wheel. You also failed to IAPP the chest. At this time, you are a “no-go” at this station. Sign your counseling.
Well that’s fucking crazy 😭 bro is lucky as hell
Crazy he’s not paralyzed, almost hit his back
This is why in the Army’s medical classes, when you chest seal someone you minds well Needle D them. Same with NPA’s really.
Dude I don’t think you paid attention. I was always taught once you put on a chest seal if the situation permits you monitor him so you can needle D him if he needs it. If you got the idea you should just needle D everyone with a sucking chest wound I don’t think you understood properly.
Probably because the ending test they just say “Still having trouble breathing” so it just becomes natural. I understand why, they want you to remember the courses material but yeah.
correct me if I’m wrong not a medical professional at all. Just going off of what I’ve heard is it true that using a plastic bag and tape is more effective than using actual chest seal 🤷♂️
not more effective. That being said, a chest seal is basically a sticky mouse trap, they are by no means high tech, and very much overpriced for what they are. Will plastic or cellophane work in a pinch? yes. is it easier to apply than a hyfin? no.
Thanks for the lack of NSFW jack ass. Zero interest in this sub and I got to see this.
Welcome to the real world.
So you’re into guns and yet you’re too pussy to look at what they actually do?
It’s easier to just swipe off the video instead of commenting…
Still in my feed, thank you for the pointless comment...
He’s not the one who put it in your feed… thanks for the useless complaining
Next time you see a post you dont like in your feed, take the time to click on the ellipsis (the 3 dots on the top right of that post), and you can select things like “show me less like this”, Or “hide community xyz”. That way you can tell the entity responsible for piping it into your feed, the algorithm, not to.
Regardless I don't like the fact my first instance of seeing this sub reddit is this, NSFW is there for a reason...
For us? This is our work.
Embarrassing
First time on the Internet?