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Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Bolin Chest Seal

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At the most recent continuing medical education (CME) meeting of the Wilderness Medical Society, Carl Weil exhibited on behalf of Wilderness Medicine Outfitters. One of the products he displayed was the Bolin Chest Seal, which is a novel product that simplifies field management for a penetrating ("sucking") chest wound, in which there is a persistent leak that not only causes a lung to collapse, but for air (sometimes with blood) to accumulate under pressure within the chest cavity between the external surface of the collapsed lung and the inside of the chest wall.

The usual teaching for improvisational management of chest wounds is that all open wounds (particularly those in which air is bubbling) should be rapidly covered, to avoid “sucking” chest wounds that could allow more air to enter the pleural space and thus continue to worsen a collapsed lung. For a dressing, a Vaseline-impregnated gauze, heavy cloth, or adhesive tape can be used. The dressing should be sealed to the chest on at least three sides. If the victim develops a tension pneumothorax (collapsed lung under pressure) following a penetrating wound to the chest and his condition deteriorates rapidly (difficulty breathing, blue skin discoloration, distended neck veins, collapse followed by unconsciousness), force a finger through the wound into the chest to allow the air under pressure to escape. If your diagnosis is correct, you will hear a hissing noise as the air rushes out. This allows the lung to partially expand and may save the victim’s life. After the release of air from a tension pneumothorax, cover the wound with a dressing and seal only three sides to create a flutter-valve effect (air can exit, but not enter) and prevent a recurrence, which might come with a complete seal.

The Bolin Chest Seal is a substitute for the above improvisations. It is designed for medical professionals, but since I have discovered that there is a substantial number of readers of this blog who fall into this category, it is useful to provide a brief description here. As advertised, "The BCS is a sterile occlusive chest wound dressing for treating open pneumothorax and preventing tension pneumothorax that result from gunshots, stabwounds, or other penetrating chest trauma. The patented failure-proof triple-valve design of the BCS allows air and blood to escape while preventing the re-entry of either, thereby eliminating any unwanted gas or liquid exchange at the trauma site.

The large (6” diameter), rugged polyurethane disc structure of the BCS can cover practically any size chest trauma site. The thickness of the disc prevents any disc wrinkling from occurring during application. In addition, the wound side of the disc is covered with a thick layer of jell-based adhesive, strong enough to not only seal over hair and blood but also flexible enough to be removed and reapplied to the trauma site if required."

This is a useful product to add to the armamentarium of the field responder who might need to manage significant chest trauma.

If you're going to be outfitting for an outdoor adventure or expedition, you can find much of what you need betweenWilderness Medicine Outfitters and Chinook Medical Gear, Inc. I couldn't find the Bolin Chest Seal at the Wilderness Medicine Outfitters website, even though it was on display at their booth, so the link above will take you to Chinook Medical Gear.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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