26 y\ o male pt with gsw to L. side upper chest wall from a 7.62 round ( casing found by atlanta pd). Entrance in front, exit wound in back. Pt. vitals: respirations 14. shallow, BP 92/68, P 126 / weak, o2 sat 96 %, warm and sweaty. Pt found lying supine on ground. Found wounds, cleaned blood and lung matter so that we could use sterile 4x4s and packaging from a abdominal dressing to seal off gsw. 3 sided occlusive anterior, 4 sided posterior. 14 g Iv in left arm, 16 g iv right arm, 0.9 % NS hung. Pt went unconsious and was intubated using 8.0 ett. Had to bolus to keep pt bp above 90 systolic. Pt made it to Grady ER where he was evaluated by staff and sent directly to OR. Called ER staff approx 2 hr later to find pt made it into surgery where he died due to blood loss from a slight aortic tear. Dressings did their job, however I had to use several strips of tape to secure them to the skin.
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Originally Posted by swatsurgeon
Gentlemen,
I would like to focus briefly on the equipment used for an open (sucking) chest wound. Multipart answer here:
1)Has anyone dealt with a true open chest wound where there was free movement of air both in and out of the pleural space, and 2) used a 3 sided dressing or asherman type device. What was the result? Did the dressing or device prevent the need to provide positive pressure ventilation (BVM or ETT intubation, etc) and most importantly, was it a true open chest wound?
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