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Clamp the the chest tube?

oded private tangentcarrot at hotmail.com
Fri Apr 7 10:07:10 BST 2006


Hello list
Iwant to bring up a subject that has been the sources for some debate over 
the past week.

It turns out  there is a new instruction for EMS paramedics to clamp a chest 
tube if there is a massive flow of blood (no numbers given) through it a 
short time after insertion, the logic being that the bleeding was probably 
tamponated before chest tube insertion, and the tube destroyed the tamponade 
effect.
To my opinion, clamping the chest tube will rarely cease the bleeding (the 
thorax can hold great amounts of blood before intrathoracic pressure rises 
above the systemic pressure, can't it? The paramedic's answer was that 
usually the bleeding will be confined by tissue and therefore a tamponade 
achived after a small amount of bleeding), and carries the complication of a 
tension pneumothorax, not to say a tension hemothorax, developing. (One 
paramedic claimed that when you have a massive hemothorax, blood filles up 
the entire availaable space in the hemithorax. not leaving any room for air, 
therefore a tension pneumothorax will not develop. What do you say about 
it?).

What do you think about it?
CTo clamp or not to clamp?

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