EMT Lesson Plans

6.13 Trauma Skills II Station: Obstructive Chest Injury Instructor Guidance

Objectives: 1. Demonstrate proper emergency medical care of a patient who has experienced a tension pneumothorax. (p 979) Setup: You will need your cohort bag. You will also need a manikin (torso or full body CPR manikin) Deployment: DO NOT LECTURE – your students should be working hands-on within 5 minutes of arriving Deploy your students in one team – one student should be patient, the rest rescuers. Have them transition through the scenario on the back of this sheet like any other scenario from a scenario lab day. During the primary assessment, the patient will need BVM ventilation. If they transition into a rapid assessment, tell them that they discover an open wound to the right anterior chest with bubbling. If they seal it with a three-sided dressing, during transport tell them that the bag is becoming difficulty to squeeze. If they reassess the dressing, tell the students the dressing has become bloodied and is sticking to the area and no longer providing a 1-way valve effect. Once students identify hypoventilation, have the manikin stand in for the live patient. Make sure they do a 3-sided dressing with tape on the manikin. Debriefing: Give students feedback on the application of the device after it is complete. Some points to discuss: - Did they quickly identify the hypoventilation and treat it with an adjunct and BVM ventilation? - Did they identify JVD and tracheal deviation? Emphasize that tracheal deviation is a late sign and not likely to be present unless the patient has lost a SIGNIFICANT amount of lung capacity - Did they find the sucking wound during secondary assessment? Did they use an occlusive dressing with 3- sided tape? - Did they recognize the resistance to the bag as tension in the thorax and trouble-shoot the dressing? Make sure they understand that these dressings get sloppy sometimes and begin to contain the pressure again instead of providing the necessary 1-way valve effect. They should understand in that circumstance the dressing should be removed, the area cleaned, and a new one applied.