Editor’s Note: This is part three of a four-part series.

The International Liaison Committee on Resuscitation (ILCOR) appointed a task force in 2013 to prepare recommendations regarding first-aid care by trained or untrained rescuers. The recommendations were released with the 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. The goal was to provide an evidence base for the initial care provided by laypersons, EMS, and physicians outside of the office or hospital setting.

ACEP Now has partnered with three emergency medicine residency training programs (Wake Forest School of Medicine, Winston-Salem, North Carolina; Mayo School of Graduate Medical Education/Mayo Clinic, Rochester, Minnesota; and Warren Alpert Medical School of Brown University, Providence, Rhode Island) to review 15 of these recommendations following the PICO (Population, Intervention, Comparator, and Outcomes) analytic format utilized by the recommendation authors.

Panel Commentators

• Howard Mell, MD, MPH, CPE, FACEP, assistant professor, Wake Forest Baptist Medical Center, Department of Emergency Medicine
• Jessica L. Smith, MD, FACEP, associate professor (clinical), Warren Alpert Medical School of Brown University, and program director, Emergency Medicine Residency
• Jason Stopyra, MD, FACEP, assistant professor, Wake Forest Baptist Medical Center, Department of Emergency Medicine
• Matthew Sztajnkrycer, MD, PHD, FACEP, associate professor, Mayo Clinic, Department of Emergency Medicine

Reference: Singletary EM, Charlton NP, Epstein JL, et al. Part 15: first aid: 2015 American Heart Association and American Red Cross guidelines update for first aid. Circulation. 2015;132(suppl 2):S574–S589.

Open Chest Wound (FA 525)

Recommendation Author: Anuradha Ganapathy, MD

Dr. Ganapathy is a member of the emergency medicine residency training class of 2018 at the Warren Alpert Medical School of Brown University.

Question: Among adults and children with open chest wounds outside of the hospital (P), does use of occlusive dressing (I) compared to non-occlusive dressing (C) change outcomes (O)?

Results: One animal study (deemed very-low-quality evidence) addressed the PICO question of use of occlusive versus non-occlusive dressings in open chest wounds for respiratory arrest and to improve oxygen saturation. Vented and unvented chest seals were placed serially on open chest wounds in eight pigs, and onset of tension pneumothorax and deterioration of respiratory parameters were measured upon serial air injections into the pleural cavity.

Outcomes: There was benefit from use of non-occlusive devices for the outcomes of respiratory arrest, oxygen saturation, tidal volumes, and respiratory rate. There was no significant benefit in terms of mean arterial pressure, survival, or cardiac arrest.