Glock 19 of IFAKs?

[TGS]

Yes, @0ddl0t, excellent question. Tac-Med Solutions has a lot of really good videos which are excellent training additions even in classes.

Here's their one on the treatment of an open chest wound as a starter, since you brought it up:



Here's a short classroom style video on a pneumothorax:




Here's one of the best demonstrations I've ever seen of a closed pneumothorax developing into a tension pneumo, so you see a visual representation of what's happening inside your body and how your lungs can't fill with air, but then also end up pressing against your heart, preventing it from pumping blood (cardiac tamponade). Note that the plastic bag represents the pleural lining ("chest wall") which as you can see when the demonstration starts, is sealed tight against the lungs. Also note that this is a fairly extreme example....it doesn't really happen this fast, but it's an excellent example of what happens, regardless.



Keep in mind that you can also experience a hemothorax, which is when the pleural cavity is filled with blood instead of air. This is an expected trauma from taking blunt force such as a steering wheel to the chest during a car accident, another relatable example to this forum being taking a 7.62x54 to a chest plate if you're not wearing underlying soft armor to absorb the trauma. Don't quote me as a source on the numbers, but IIRC during the Soviet-Afghan War, some absurdly high number around 80% of soviet troops who took a 303 or 7.62x54 round to their plates ended up dying within 3 days due to hemothoraces, as this type of injury was not treatable until they got back to their primary evac hospital in Kazakhstan.....which would usually take 3 days minimum from the field hospital in Afghanistan.

[0ddl0t]

Fantastic post, thank you TGS!

[Yute]

Good video series. Going to get in the weeds here if you don't mind.

My only issue with video 2 is that it makes it sound like tension pneumothoraxes are singularly caused by penetrating wounds chest that act as a "one way valve". This is often repeated as dogma in textbooks but we know this is not the case as evidenced by excellent video #3 where we see tension pneumothorax being caused by a lung with an air leak into the pleural space without an open chest wound. We see this blast injuries, blunt trauma to the chest, a patients being bagged/on ventilators.


The trap I see a lot of my Soldiers fall into is:

1. Thinking that by applying a chest seal on a chest wound they've "treated" a tension pneumothorax when in fact they could be causing one. A vented chest seal does not treat a tension pneumothorax; it only prevents the progression of a tension pneumothorax. The treatment of a tension pneumothorax is the relief of pleural space pressure either by chest seal removal (if present), needle decompression, and/or thoracotomy/chest tube placement .

2. Failing to realize that you can develop a tension pneumothorax even without an open chest wound.

Dr. Shertz has an excellent discussion of this titled A sucking (and blowing) chest wound is the sound of not dying

Dr. Shertz's Crisis Med incidentally does offer online classes; I have not taken them but have been impressed with Dr. Shertz's lectures.

[Dave Williams]

Good video series. Going to get in the weeds here if you don't mind.

My only issue with video 2 is that it makes it sound like tension pneumothoraxes are singularly caused by penetrating wounds chest that act as a "one way valve". This is often repeated as dogma in textbooks but we know this is not the case as evidenced by excellent video #3 where we see tension pneumothorax being caused by a lung with an air leak into the pleural space without an open chest wound. We see this blast injuries, blunt trauma to the chest, a patients being bagged/on ventilators.


The trap I see a lot of my Soldiers fall into is:

1. Thinking that by applying a chest seal on a chest wound they've "treated" a tension pneumothorax when in fact they could be causing one. A vented chest seal does not treat a tension pneumothorax; it only prevents the progression of a tension pneumothorax. The treatment of a tension pneumothorax is the relief of pleural space pressure either by chest seal removal (if present), needle decompression, and/or thoracotomy/chest tube placement .

2. Failing to realize that you can develop a tension pneumothorax even without an open chest wound.

Dr. Shertz has an excellent discussion of this titled A sucking (and blowing) chest wound is the sound of not dying

Dr. Shertz's Crisis Med incidentally does offer online classes; I have not taken them but have been impressed with Dr. Shertz's lectures.

He's a pretty hardcore guy, I was super impressed by his lecture I attended.

[Warped Mindless]

Good video series. Going to get in the weeds here if you don't mind.

My only issue with video 2 is that it makes it sound like tension pneumothoraxes are singularly caused by penetrating wounds chest that act as a "one way valve". This is often repeated as dogma in textbooks but we know this is not the case as evidenced by excellent video #3 where we see tension pneumothorax being caused by a lung with an air leak into the pleural space without an open chest wound. We see this blast injuries, blunt trauma to the chest, a patients being bagged/on ventilators.


The trap I see a lot of my Soldiers fall into is:

1. Thinking that by applying a chest seal on a chest wound they've "treated" a tension pneumothorax when in fact they could be causing one. A vented chest seal does not treat a tension pneumothorax; it only prevents the progression of a tension pneumothorax. The treatment of a tension pneumothorax is the relief of pleural space pressure either by chest seal removal (if present), needle decompression, and/or thoracotomy/chest tube placement .

2. Failing to realize that you can develop a tension pneumothorax even without an open chest wound.

Dr. Shertz has an excellent discussion of this titled A sucking (and blowing) chest wound is the sound of not dying

Dr. Shertz's Crisis Med incidentally does offer online classes; I have not taken them but have been impressed with Dr. Shertz's lectures.

Thanks for leading me to Dr. Shertz and his online courses. Looks like they will be a great refresher when I do my yearly refresher and Im going to give out his $25 Trauma Essentials course to several family members for Christmas.

[Doc_Glock]

This is the first time I've heard this. It's a skill taught in layperson classes.



Specific application to TCCC or even domestic MCIs depending on agency protocols.

In the use of the MARCH algorithm, I can't hold a jaw trust on one patient and simultaneously move to do MA on another. NPAs are space efficient, the brain-tubing concern is more of a extremely low probability hypothetical, and NPAs allow me to perform M and A on a patient and then move on to the other patients in my vicinity before going back around and reassessing/addressing RCH.

An unconscious casualty can still have spontaneous breathing but be in danger of losing their airway, and recovery position isn't always an option. Patient movement is a surefire portion where this can matter......you can't hold a jaw-thrust while moving somebody unless you've got a stretcher and being VERY deliberate (slow) and coordinated as a team, and most improvised patient movement techniques can induce an airway obstruction. An NPA mitigates all of this, regardless of whether you need to assist ventilations or not.

For these reasons, NPAs have a strong place in IFAKs. I don't teach them in my lay person classes but that's a decision based 100% in liability management in 21st century America rather than any actual good reason.

100% agreed. I have a pretty minimal kit, Gloves, TQ, large bore needles and NPA pretty much. The NPA is space efficient, light, easy to use, lifesaving in the right circumstance, I see no reason not to have one.