Clamp the the chest tube?

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This is a classic old wives' tale that was debunked over 30 years ago, and never had any evidence to support it.  It defies logic to clamp a chest tube, as then you may as well not have the chest tube.  The blood in the chest is ALREADY LOST from the circulation, it is doing only harm by sitting in the chest  and needs to be removed regardless how much there is--in fact, the more there is, the more important to remove.  If there is continued bleeding, that is a valuable clue of the need for thoracotomy to stop it that will otherwise be lost.  A surgeon needs to stop the bleeding, and clamping the tube will NOT stop the bleeding if it is still going on, it will just cause more harm to the heart and lung if left in the chest.  Anyone who insists on this should be challenged to show you the slightest bit of evidence to suppport it---and of course they cannot, telling you something important right there about how active is their imagination.
It continues to amaze me how in 2006 such garbage continues to be propagated by these masters of ignorance.
ERF
ERF
 
-----Original Message-----
From: oded private <tangentcarrot at hotmail.com>
To: trauma-list at trauma.org
Sent: Fri, 07 Apr 2006 12:07:10 +0300
Subject: Clamp the the chest tube?


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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