Need some information Re: Chest Wounds

[Leftie]

Whereas I think the clinically appropriate thing to would be to assess the patient and determine whether or not the wound is clinically relevant. The wound isn't the problem. The physiological effect of the wound is the problem. Is the patient ventilating? Oxygenating? Is there JVD? Tracheal deviation? BP? Heart rate? Those things all go into the decision matrix as to how that wound is managed in the field and are more important than the mere fact that there is a chest wound.

This is where "protocol" and context become difficult to navigate, and there isn't a definitive answer. Those of us with some experience in the medical community (either in EMS/prehospital settings or in definitive care settings), no matter what level of experience or expertise have all probably fallen into the paradox of "well if I choose this intervention based upon what signs/symptoms I am seeing, it might deviate from a textbook protocol... BUT IT WILL PROVIDE A BETTER PATIENT OUTCOME and greater chance of survivability." This calculus is nearly entirely based on a sound assessment of a real patient and the hierarchies found within provision of care based upon what you are observing.

I would say that a good bet is to follow local/your agency's SOPs, and follow whichever acronym they have adopted, but recognize that others exist and that there are nuances between them. MARCH, H-ABC, SCAB-E, CAB etc... they all have nearly identical priority hierarchies, and controlling hemorrhage falls above nearly everything else... in context. On the other hand, once you've fixed the massive bleed, I don't see anything wrong with properly applying a chest seal per SOP and monitoring the patient for signs of respiratory difficulty and tension pneumothorax, and then "burping" the seal as needed, but really, it's contextual to the extent of trying to figure out what will kill the patient first and fastest, and then solving for said problem. It's really hard to mess up a chest seal if you are continuously monitoring your patient's status and understand how the intervention works.

Even then... I've seen laypeople taught how to properly apply chest seals by my jurisdiction's medical director, and while the signs and symptoms of tension pneumothorax were discussed and taught to them, in the context of where this training is being held (an area where a Level I trauma center is no more than 15 minutes away at any time) he isn't concerned about tension pneumos.

For reference, my experience is at the prehospital level, so your mileage may vary with the above.