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Sat, 23 Feb 2002 11:19:37 -0000

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Ian,

If an isolated tension pneumothorax is successfully relieved then the sig=
ns of respiratory distress, shock and level of consciousness should impro=
ve. Needle decompression is, however, notoriously unreliable when perform=
ed in hospital, let alone in the situation you describe. =20

If I was assisting you at the accident scene, I would be asking your coll=
eagues to extricate the patient immediately with spinal immobilisation of=
 very low priority. Once 360 degrees of access to the patient had been es=
tablished, there is then the best opportunity to adequately address the p=
atient's immediate clinical needs.

John Black
Consultant in Emergency Medicine
John Radcliffe Hospital
Oxford, UK

Message: 10
From: "Ian Cross" <ian_ff@hotmail.com>
To: trauma-list@trauma.org
Subject: Tension Pneumothorax
Date: Fri, 22 Feb 2002 14:32:49 +0000
Reply-To: trauma-list@trauma.org

I'm a fire-fighter working in a very rural community.  We don't see that
much trauma, but on occasions the country roads have a habit of exposing
some nasty injuries.

We have just been through the trapped occupant/tension pneumothorax
experience.

having read as much as I can on this subject, (with the small amount of
literature I have available).

The signs of a developing T.P. are well described and the procedure of
needle decompression is also
well described.

However it is mentioned by those in the emergency services (paramedics wh=
o
we occasionally get to chat with).

Needle decompression is only successful in about 40% of cases, - fat cell=
s
are jammed into the cannula
In needle decompression the 'classical hiss of air being released' is oft=
en
not present.
In T.P. the lung will not re-inflate once the tension has been relieved.

Is all the above correct ?

If so how would one know that the decompression has worked ?

Does the increasing respiratory rate, slow down, does the respiratory rat=
e
decrease ?

The the patients anxiety and distress reduce ?

i can find no literaturew that describes the outcome of successful
decompression and as yet no one to answer my questions.

Can someone please help.  Not that we would be in a position to provide t=
his
procedure for a patient, it is just a question that I find very interesti=
ng
and cannot find an answer.

Ian Greaves, Fire-fighter, The highlands of ScotlandGet more from the Web=
.  FREE MSN Explorer download : http://explorer.msn.com

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<HTML><BODY STYLE=3D"font:10pt verdana; border:none;"><DIV>Ian,</DIV> <DI=
V>&nbsp;</DIV> <DIV>If an <U>isolated</U> tension pneumothorax is success=
fully relieved then the signs of respiratory distress, shock&nbsp;and lev=
el of consciousness&nbsp;should improve. Needle decompression is, however=
, notoriously unreliable when performed in hospital, let alone in the sit=
uation you describe. </DIV> <DIV>&nbsp;</DIV> <DIV>If I was assisting you=
 at the accident scene, I would be asking your colleagues to extricate th=
e patient immediately with spinal immobilisation&nbsp;of very low priorit=
y. Once 360 degrees of access to the patient had been established, there =
is then the best opportunity to&nbsp;adequately address the patient's imm=
ediate clinical needs.</DIV> <DIV>&nbsp;</DIV> <DIV>John Black</DIV> <DIV=
>Consultant in Emergency Medicine</DIV> <DIV>John Radcliffe Hospital</DIV=
> <DIV>Oxford, UK</DIV> <DIV>&nbsp;</DIV> <DIV>Message: 10<BR>From: "Ian =
Cross" &lt;<A href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002/3D"msn://@mail.mar@/compose.htm?NW=3Dtrue&amp;mailto:i=
an_ff@hotmail.com">ian_ff@hotmail.com</A>&gt;<BR>To: <A href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002/3D"http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002/msn://@ma=
il.mar@/compose.htm?NW=3Dtrue&amp;mailto:trauma-list@trauma.org">trauma-l=
ist@trauma.org</A><BR>Subject: Tension Pneumothorax<BR>Date: Fri, 22 Feb =
2002 14:32:49 +0000<BR>Reply-To: <A href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002/3D"http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002/msn://@mail.mar@/compose.htm?=
NW=3Dtrue&amp;mailto:trauma-list@trauma.org">trauma-list@trauma.org</A><B=
R><BR>I'm a fire-fighter working in a very rural community.&nbsp; We don'=
t see that<BR>much trauma, but on occasions the country roads have a habi=
t of exposing<BR>some nasty injuries.<BR><BR>We have just been through th=
e trapped occupant/tension pneumothorax<BR>experience.<BR><BR>having read=
 as much as I can on this subject, (with the small amount of<BR>literatur=
e I have available).<BR><BR>The signs of a developing T.P. are well descr=
ibed and the procedure of<BR>needle decompression is also<BR>well describ=
ed.<BR><BR>However it is mentioned by those in the emergency services (pa=
ramedics who<BR>we occasionally get to chat with).<BR><BR>Needle decompre=
ssion is only successful in about 40% of cases, - fat cells<BR>are jammed=
 into the cannula<BR>In needle decompression the 'classical hiss of air b=
eing released' is often<BR>not present.<BR>In T.P. the lung will not re-i=
nflate once the tension has been relieved.<BR><BR>Is all the above correc=
t ?<BR><BR>If so how would one know that the decompression has worked ?<B=
R><BR>Does the increasing respiratory rate, slow down, does the respirato=
ry rate<BR>decrease ?<BR><BR>The the patients anxiety and distress reduce=
 ?<BR><BR>i can find no literaturew that describes the outcome of success=
ful<BR>decompression and as yet no one to answer my questions.<BR><BR>Can=
 someone please help.&nbsp; Not that we would be in a position to provide=
 this<BR>procedure for a patient, it is just a question that I find very =
interesting<BR>and cannot find an answer.<BR><BR>Ian Greaves, Fire-fighte=
r, The highlands of Scotland<BR><BR><BR><BR></DIV></BODY></HTML><br clear=
=3Dall><hr>Get more from the Web.  FREE MSN Explorer download : <a href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002/3D=
'http://explorer.msn.com'>http://explorer.msn.com</a><br></p>

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