Im Rahmen von bedrohlichen Lagen muss mit penetrierenden Verletzungen der Thoraxwand gerechnet werden, die mit speziellen Thoraxpflastern, sog. Chest Seals, abgedichtet werden können. Da Chest Seals zur Ausstattung von Spezialeinheiten des Militärs und der Polizei gehören, ist es durchaus denkbar, dass Notärzte und Rettungsdienstfachpersonal in bedrohlichen Lagen mit Patienten konfrontiert werden, die mit einem solchen Pflasterverband versorgt sind.
Abstract
In case of threatening situations penetrating injuries of the chest are frequent and can be sealed by certain dressings, so-called chest seals. As chest seals are used within special forces of the military or the police, EMS-personnel may cope during threatening situations with patients having a chest seal applied. In this non-systematical review the characteristics of chest seals and their indication to be used in a civilian environment are highlighted on the basis of a literature research and personal knowledge.
Chest seals are vented or non-vented, adhesive dressings to cover sucking chest wounds, in order to prevent a tension pneumothorax if the wound works as one-way valve. Animal studies showed that chest seals are able to stabilize respiratory parameters if applied in case of open pneumothorax. However only vented chest seals were able to prevent a tension pneumothorax in case of additional damage of the airways. In contrast to civilian guidelines (like the ERC-guideline) tactical orientated guidelines recommend the use of vented chest seals to cover sucking chest wounds in an austere environment. The use of vented chest seal in a threatening situation might be useful to temporarily stabilize the patient’s respiratory parameters and to prevent a tension pneumothorax. However, a tension pneumothorax might still occur. Therefore, a frequent reevaluation, as wells as an early and sufficient treatment of a developing tension pneumothorax by thoracostomy is necessary.
Schlüsselwörter Thoraxpflaster - Thoraxtrauma - Spannungspneumothorax - bedrohliche Lagen - Taktische Medizin
Keywords Chest Seal - chest trauma - pneumothorax - tension pneumothorax - tactical medicine
