MEDICAL
Chest Seals in an MCI
Do penetrating chest injuries in an MCI need a chest seal? The answer is more nuanced than most training suggests.
An injury to the chest can be one of two problems: a breathing problem or a bleeding problem. A pneumothorax is a breathing problem — it can be caused by any hole in the chest, either from the inside (a tear in the lung from a rib fracture) or from a gunshot wound.
You can also have a bleeding problem, with massive bleeding from the lung after an open chest injury from a gunshot. The open injury and breathing problem is easily fixed with a chest seal and can be applied in the field. The closed pneumothorax is fixed in the hospital by making a hole, putting a chest tube in, and connecting it to suction.
The bleeding problem from a gunshot is far more concerning. There can be massive blood loss that can only be fixed by a staple line across the lung injury in the operating room. So what if you seal the hole? The volume of blood can fill the chest cavity and push the heart and great vessels to the other side — "kinking" the vessels, preventing blood flow, dropping blood pressure, and reducing perfusion of the head and major organs. This is the dreaded Tension Pneumothorax.
To treat this and relieve the tension, you open the hole (Burp) that you sealed to release the pressure.
So why did you seal the hole in the first place? They need rapid evacuation to a higher level of care. Just a thought.