Respirations and the Chest Seal, vented or non vented?

The final “stabilizing” step in March is Respirations. In Respirations, we are making sure that the lungs fill up with air so that the rest of your body can get the oxygen it needs.

We start this by removing any clothing or equipment that is covering the chest. We need the full trunk exposed so that we can do a blood sweep on the chest in order to identify any holes that need to be sealed. Your respiratory system works on changing pressures. When you inhale your diaphragm pulls down it creates negative pressure in your lungs which causes them to fill with air. When you exhale your diaphragm pushes up it creates positive pressure which pushes the air out of your lungs. When you start putting holes in the wall is when things start to stop working properly.

If you find a hole in the trunk, you will want to seal it. There are many different types of chest seals available. Most work fairly well. Halo’s and Hyfins both work extremely well. Next comes the natural question of vented vs unvented. Vented chest seals include some sort of vent built into the chest seal. They work very well until they don’t. I do include them in my IFAK because I think they should be included, but I would not feel out of sorts if I had to use a non-vented seal. You can also improvise a chest seal with something that is occlusive and some high-quality tape. Tape all around the edges. 2-3 inches from the edge of the wound to the edge of the tape. They used to teach that you should leave a vent available when you tape it, but it didn’t work in practice. So just tape all around it.

If you find a hole in the chest you will want to check the other side of the trunk. We will sweep the back either way though. So we will roll them onto their stomach in order to facilitate this. While they are on their stomach this would be a good time to get a litter ready to transport them to our treatment area. Make sure there is some sort of hypothermia prevention on the litter as well.

One thing to look out for is tension pneumothorax. This is where pressure will start to build up in the chest cavity and deflate the lung and in turn, start to push on the heart and the other lung. You will notice this from the unequal rise and fall of the chest specifically on the injured side. If the casualty is conscious they may complain of it being hard to breathe on the injured side or will say that side of their chest feels tight. The final sign will be a deviated trachea. It will deviate to the uninjured side because the collapsed lung is pushing everything to the uninjured side. A deviated trachea is a very late sign of tension pneumothorax. Regardless of whether you use a vented or a non-vented, you are going to want to “burp” the chest seal. Even a vented chest seal can clog with debris, blood, tissues, etc. If they do clog, they will stop venting properly. To burp the chest seal you will pull back until you expose the wound, you will then wipe away at the wound to clear out any crud that has blocked the hole, and then you will place the chest seal back on.  If you do not have any tape securing the chest seal on, you will want to add some now. Any time you remove a commercial chest seal you are potentially reducing the ability of the adhesive to work properly. So back it up with tape, it’s cheap. Make sure you record the time that you have burped that chest seal.

After that, there isn’t too much at a basic level that we can concern ourselves with. Just be sure to keep checking for tension pneumothorax.

We’ve got classes on the schedule, I have one this month out at Bob Griswold’s training location in Tellico Plains. It is guaranteed to be a good time.

What chest seal do you run in your kits, and do you prefer vented, or unvented?