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Sat, 21 Jun 2003 03:42:22 EDT

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I respect your position Nick.  When I was helping in the instruction of 
paramedics in GA we performed the procedures on animals that were involved with 
veterinary procedures (live) or were purposely used to teach the procedure where 
paramedics got the chance to do the invasive procedure multiple times as 
needed, With significant proximal cervical swelling circus, even surgical, may not 
be able to be done as a surgical trach would be the ticket.  I of course don't 
equate rapid thoracotomy with surgical trach but the two procedures do have 
these similarities 1. They would only be done by a medic trained and found to 
be competent in the procedure and in cases were criteria are met, all approved 
by the med director prior (the hardest part politically to get passed) 2. They 
would only be used in a clinically dead to dying patient where no other 
alternative is present.  3. they both require basic surgical skill and knowledge of 
anatomy as well as practice (prob could teach in one day long session as I 
have done before for veterinary students when they learn how to perform 
resuscitative thoracotomies and open chest CPCR (with aortic cross clamping using a 
feeding tube) because in dogs and cats the clinical effectiveness of closed 
chest CPCR is only less than 1/3rd as effective in generating good cerebral blood 
flow when compared to open chest CPCR.   We do not mess around with close 
chest CPCR in trauma arrests or near arrests. We use the Doppler blood flow 
detector to help us make the decision to continue to perform  closed chest CPCR or 
move to open methodology.  At the conclusion of the CPR chapter in the last 
edition of Shoemaker the author states categorically that open chest CPR should 
be done more in CAs (medical) and certainly surgical (trauma) related.  There 
is nothing like opening the chest of a CA pt that results in a rush of air 
leaving the chest and the return of spontaneous cardiac filling!  A very 
significant result..the rapid decompression of a tension pneumothorax and return to 
life of a victim that without that aggressive treatment would have succumbed for 
sure.  Enough to chew on for a while. Tim

Dennis T. (Tim) Crowe, Jr., DVM, DACVS, DACVECC, NREMT-II, PI, FF
Veterinary Surgery and Emergency - Critical Care Consulting
2621 Simons Court, Carson City, Nevada 89703
phone and fax 775-841-6821  crowehome@aol.com
Clinical Associate Professor, The Institute of Critical Care Medicine
1695 N Sunrise Way, Palm Springs, CA 92262   760-788-4911 

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<HTML>I respect your position N=
ick.&nbsp; When I was helping in the instruction of paramedics in GA we perf=
ormed the procedures on animals that were involved with veterinary procedure=
s (live) or were purposely used to teach the procedure where paramedics got=20=
the chance to do the invasive procedure multiple times as needed, With signi=
ficant proximal cervical swelling circus, even surgical, may not be able to=20=
be done as a surgical trach would be the ticket.&nbsp; I of course don't equ=
ate rapid thoracotomy with surgical trach but the two procedures do have the=
se similarities 1. They would only be done by a medic trained and found to b=
e competent in the procedure and in cases were criteria are met, all approve=
d by the med director prior (the hardest part politically to get passed) 2.=20=
They would only be used in a clinically dead to dying patient where no other=
 alternative is present.&nbsp; 3. they both require basic surgical skill and=
 knowledge of anatomy as well as practice (prob could teach in one day long=20=
session as I have done before for veterinary students when they learn how to=
 perform resuscitative thoracotomies and open chest CPCR (with aortic cross=20=
clamping using a feeding tube) because in dogs and cats the clinical effecti=
veness of closed chest CPCR is only less than 1/3rd as effective in generati=
ng good cerebral blood flow when compared to open chest CPCR.&nbsp;&nbsp; We=
 do not mess around with close chest CPCR in trauma arrests or near arrests.=
 We use the Doppler blood flow detector to help us make the decision to cont=
inue to perform&nbsp; closed chest CPCR or move to open methodology.&nbsp; A=
t the conclusion of the CPR chapter in the last edition of Shoemaker the aut=
hor states categorically that open chest CPR should be done more in CAs (med=
ical) and certainly surgical (trauma) related.&nbsp; There is nothing like o=
pening the chest of a CA pt that results in a rush of air leaving the chest=20=
and the return of spontaneous cardiac filling!&nbsp; A very significant resu=
lt..the rapid decompression of a tension pneumothorax and return to life of=20=
a victim that without that aggressive treatment would have succumbed for sur=
e.&nbsp; Enough to chew on for a while. Tim 
 
Dennis T. (Tim) Crowe, Jr., DVM, DACVS, DACVECC, NREMT-II, PI, FF 
Veterinary Surgery and Emergency - Critical Care Consulting 
2621 Simons Court, Carson Ci=
ty, Nevada 89703 
phone and fax 775-841-6821&nbsp; crowehome@aol.com 
Clinical Associate Profes=
sor, The Institute of Critical Care Medicine 
1695 N Sunrise Way, Palm Spr=
ings, CA 92262&nbsp;&nbsp; 760-788-4911 </HTML>

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