Page 91 - Journal of Special Operations Medicine - Fall 2017

Table 2 Demographics and Clinical Data of Patients With Figure 1 HALO chest seal (nonvented).
Penetrating Wounds With a Chest Seal Placed Versus No Chest Seal
With Without
Chest Seal Chest Seal
Parameter (n = 46) (n = 16) p Value
Vital signs (± SD)
Heart rate per min 99.2 (23.3) 108.8 (29.8) .228
(n = 55)
Systolic blood pressure, 118.3 (22.9) 118.8 (21.7) .953
mmHg (n = 48)
Respiratory rate per min
(n = 54) 21.5 (7.1) 25.2 (7.5) .114
Pulse oximetry, % 95.7 (4.7) 97.3 (2.0) .288
Mental status, % (no.) .165
Alert 58.7 (27) 50.0 (8)
Verbal 15.2 (7) 18.8 (3)
Pain 2.2 (1) 0 (0)
Unresponsive 23.9 (11) 18.8 (3)
Unknown 0 (0) 12.5 (2) Source: http://www.chinookmed.com/cgi-bin/item/12099/s-chest
_thoracic/-HALO-Seals-(2pk)
MOI, % (no.) .037
GSW 82.6 (38) 50.0 (8) Figure 2 HyFin chest seal (nonvented).
Explosive 15.2 (7) 43.8 (7)
GSW + explosive 2.2 (1) 6.3 (1)
Affiliation, % (no.) .332
a
AFG 76.1 (35) 68.8 (11)
CON 10.9 (5) 25.0 (4)
SOCOM 13.0 (6) 6.3 (1)
Evacuation priority, % (no.) .11
Urgent 93.5 (43) 75.0 (12)
Priority 6.5 (3) 18.8 (3)
Routine 0 (0) 6.3 (1)
Provider level, % (no.) .839
Medical officer 63.0 (29) 68.8 (11)
Medic 26.1 (12) 18.8 (3)
Unknown 10.9 (5) 12.5 (2)
Outcome, % (no.) .894
b
Alive 15.2 (7) 18.8 (3) Source: https://www.narescue.com/hyfin-chest-seal
Dead 4.3 (2) 6.3 (1)
Figure 3 H&H Bolin chest seal (vented).
Unknown 80.4 (37) 75.0 (12)
b
Trauma scores, median
(average); IQR
17 (18.1); 1 (15.7);
ISS (n = 12) .482
11–25 1–23
5 (5); N/A
AIS BR-3 (chest, n = 9) 3 (3.4); 3–4 .222
(n = 1)
AFG, Afghan; AIS, Abbreviated Injury Scale; BR, body region; CON,
conventional; GCS, Glasgow Coma Scale; GSW, gunshot wound; IQR,
interquartile range; ISS, Injury Severity Score; MOI, mechanism of in-
jury; SD, standard deviation; SOCOM, Special Operations Command.
a Based on the affiliation of the subject, not the unit of the provider.
b Data points were included when available from the DoDTR;, several
patients were unable to be linked to the DoDTR or were missing data
points. Source: http://buyhandh.com/products/bolin-chest-seal

had a CT or NCD performed, and 50.0% (n = 8) did not; the of 62) with documented penetrating chest injuries underwent
remaining three (18.8%) cases had missing documentation. chest seal placement. The information in the reference data-
base, unfortunately, does not indicate if the injuries were deep
Discussion or large enough to result in open pneumothoraces or suck-
ing chest wounds. Therefore, providers may have deferred oc-
The primary objective of this report was to measure prehos- clusive dressing placement in some cases because the wound
pital adherence to published TCCC guidelines for placement was superficial or small. Such reasoning, however, likely does
of vented occlusive dressings over open and sucking chest not apply in the setting of a GSW to the chest, and 17.4% of
wounds. Our data indicate that 74.2% of patients (n = 46 patients with GSWs to the chest (n = 8 of 46) did not undergo

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