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Thu Jul 3 21:13:47 BST 2003

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As presented, I would do nothing more than transport in the field and 
certainly NOT insert a chest tube or do a needle decompression.   I would NOT start 
ANY IVs in this patient in the field and would certainly NOT open two IVs up 
wide open.  That would create far more problems than it would potentially solve. 
  In the EC, I would use well published criteria for opening the chest in the 
EC.  As presented there are NO indications for a thoracotomy in the EC or 
even the OR.   Should he suddenly (and most who do deteriorate, do not just 
"suddenly" crash), deteriorate in the EC, I would get him to the OR for an incision 
of appropriate election.  I do not have enough information right now to 
determine that incision.   I would NOT do a subxyphoid pericardiotomy and would be 
critical of anyone who would do that in this patient.  I would do a chest 
X-ray and a FAST of the pericardium.   I would NOT do a pericardiocentesis and 
would be critical of anyone who did one.   

k

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<HTML><FONT FACE=3Darial,helvetica><FONT  SIZE=3D2 FAMILY=3D"SANSSERIF" FACE=
=3D"Arial" LANG=3D"0">As presented, I would do nothing more than transport i=
n the field and certainly NOT insert a chest tube or do a needle decompressi=
on.&nbsp;&nbsp; I would NOT start ANY IVs in this patient in the field and w=
ould certainly NOT open two IVs up wide open.&nbsp; That would create far mo=
re problems than it would potentially solve.&nbsp;&nbsp; In the EC, I would=20=
use well published criteria for opening the chest in the EC.&nbsp; As presen=
ted there are NO indications for a thoracotomy in the EC or even the OR.&nbs=
p;&nbsp; Should he suddenly (and most who do deteriorate, do not just "sudde=
nly" crash), deteriorate in the EC, I would get him to the OR for an incisio=
n of appropriate election.&nbsp; I do not have enough information right now=20=
to determine that incision.&nbsp;&nbsp; I would NOT do a subxyphoid pericard=
iotomy and would be critical of anyone who would do that in this patient.&nb=
sp; I would do a chest X-ray and a FAST of the pericardium.&nbsp;&nbsp; I wo=
uld NOT do a pericardiocentesis and would be critical of anyone who did one.=
&nbsp;&nbsp; <BR>
<BR>
k</FONT></HTML>

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