Page 167 - JSOM Fall 2020

the design features are the adhesion profile and the vent de- However, it should still be advised to be cautious about overtight-
sign. As reported in the introduction, there are several dressing ening of straps, etc., which may ultimately cause full occlusion.
designs on the market currently, which use different technol-
ogies. A new dressing design has been developed with the ob- The three zones of vents have also been designed to prevent any
jective of trying to minimize potential failings observed and channeling of the outer vent layer from the inner central open-
reported with existing dressing. 8 ing to the outer vent area on flat, concave, or convex surface
or being created when folded within the IFAK or medical kit.
With respect to adhesion profiling of the adhesive technology Channeling within existing formats of commercially available
used within the new vented chest seal design, the data within chest seal dressing may result in the product permanently vent-
this study indicate that the adhesive characteristics are capable ing, resulting in the casualty requiring further medical attention
of adhering to skin under all austere conditions. These condi- due to external pressure/air entering the pleural cavity space.
tions included below-freezing conditions, ambient conditions,
and very hot conditions, representative of the different global Conclusion
environmental zones. The results show that over all these con-
ditions, there is minimal difference in the ability for the design The recommended application of a vented chest seal in manag-
6
to adhere, even suggesting that in hotter climates the adhesive ing open pneumothorax by the TCCC is intended to provide
properties may increase. The adhesive technology within the the casualty with the optimal at-point care and increase the
product helps reduce the risk of failure during use, in that it likelihood of survival. It is, therefore, critical during the design
maintains the product in place over the wear time, allowing and development process of such products to introduce design
the casualty to obtain further medical assistance and evacua- features that help support this objective and do not introduce
tion. The adhesive technology also minimizes the risk of blood further risks. The development of this new design for a vented
leakage finding a pathway under the adhesive skin contact chest seal has been tested for adhesion technology and venting
layer, which may further result in product failure. properties and shown to have performance criteria suitable for
the treatment of open pneumothorax and design features that
When subjected to dirty skin, sweaty skin, hairy skin, and have the potential to minimize risk of product failure during use.
a combination of each condition, both in vitro and in vivo
testing demonstrated that the adhesion technology within the Conflict of Interest
new design still functions. This is also a key design feature, as All authors are employees of Medtrade Products Ltd, Crewe,
often this type of injury and medical intervention are under UK.
conditions that would create such an environment. It is still
advisable to clean the area around the wound before product References
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casualties. MJAFI. 1997;53:111–115.
Only acidic sweat was tested; alkaline sweat adhesion test- 3. Lichtenberger JP, Kim AM, Fisher D, et al. Imaging of combat-re-
ing was not assessed. Alkaline sweat is created from the use lated thoracic trauma: review of penetrating trauma. Mil Med.
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testing was intended for, alkaline sweat will not be a factor. 2020. emedicine.medscape.com
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and, therefore, will not create alkaline sweat. The mean pH of pneumothorax in fatally wounded combat casualties. J Trauma.
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Maintaining the product in place is the first key element of the seals differ in efficacy? An experimental evaluation using a swine
new design. The second key element is the vent functionality. hemopneumothorax model. J Trauma Acute Care Surg. 2017;83:
182–189.
The new design has three zones, with each zone having eight 10. Prometheus Medical Ltd. Russell chest seal whitepaper: recent
vents. In total, there are 512 pathways for air and fluid to es- independent studies with Russell chest seal. 2017. https://www.
cape from the dressing. This design feature allows the dressing prometheusmedical.co.uk/sites/default/files/fileman/uploads/
to be placed at any angle (360° orientation), making it intui- Recent%20Independent%20Studies%20on%20the%20Rus-
sell%20Chest%20Seal.pdf
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udate from the wound would follow a path related to gravity. textiles to perspiration
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one or more of the vents is obstructed. prevention of tension pneumothorax in a communicating pneu-
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