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Sun Sep 26 16:12:58 BST 2004

Charles, although I do agree with most of you statement, you did make one mistake.  As a medic, my standard level of practice says that all I decompress is a tension pneumo.  Now, understandably, if i dart a chest, i'm probably going to get some blood due to the high occurance of hemo-pneumothoraces, based simply on the mechanism of getting each, but unless the patient is crashing with obvious signs of a TENSION peumo, they dont get the needle.  

I would be interested to hear any medics that were taught differently, or have different protocols, because the other way just makes no sense to me.

Jason Cabral
EMT-P

Charles Brault <c_brault at yahoo.com> wrote:
--- KMATTOX at aol.com wrote:

> NO data exists to support continuing this urban myth. Tension 
> pneumothorax does indeed occur, but its presence is much less than 
> an over eager emergency physician, surgeon, or paramedic think it 
> exists. 

Much less
Indeed

But it does occur
And remains lethal

Properly and conservatively applied Chest Needle Deompression
... on a simple Penumo
Is the least Trauma on the most traumatised

Not to mention that 
My experience is, that
The liberal and cavalier use of CND
Is more a practice of the specialist (Surgery, Neonate... )
Than that of GPs, Medics (Hey ! I may be wrong)

By all means we have to continue to emphasize clinical training and
tempering of "Over eagerness"

But do not officialy condone here the ignoring of Tension
Pneumothoraces (What it will just go away ???)

I recall
A similar argument against the use of the Combitube !
(Maybe from you)))
Such a blunt and imperfect E.T. Tube !

How about
Medics
Such a blunt and imperfect Doctor !

E.R. Docs
Such a blunt and imperfect Anesthetist, Surgeon, radiologist...etc!

One's fixation on the imperfection
May make one blind to whatever overall utility 
an action/person may have

Your concern is full flush valid
Your perfection based objectivity is noted

But
At this point the evidence you proclaim
Is just not "evident"

It's just not their
Not in an EBM form

Not yet

> Undoubtedly more harm has been done by this seemingly innocent 
> procedure than we all would admit. 
> 
> If anyone, ANYONE, on this list still believes in this tactic, then
> it is up to them to produce evidence data in the form of a 
> prospective study to prove it. 

N O P E

It's THE standard level of practice

It's up to YOU

To show it's detrimental
Further than a few choice stories
None of them involving Prehosp
And all involving Trocard chest tube

Don't ask of us
What you are not able to provide

Do I make sense ?)))

Charles
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Needle decompression for hemothoracies ! ?(((