List Archives

Fri Apr 7 22:28:56 BST 2006

The last time I saw a medic "needle a chest" it was an awake and alert
patient with SOB, normal blood pressure and no other documented signs of
tension pneumo. Victim of car crash.

After the attempt the medic reported the patient "felt much better"

In ED patient did not have a pneumothorax and the needle track was confined
to the chest wall muscles, did not even reach the pleural cavity (cool CT
picture though of the needle air track angling AWAY from the pleural space).

Fortunately did not cause pt to have a pneumo but so much for the
prehospital care.

Pt probably told medic he felt better because he was afraid of getting
stabbed again.

Andrew Bowman

----- Original Message ----- 
From: "Bjorn, Pret" <pbjorn at emh.org>
To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
Sent: Friday, April 07, 2006 3:33 PM
Subject: RE: Re: Clamp the the chest tube in an EMS placed chest tube

>
> -----Original Message-----
> From: kokaramc at bellsouth.net [mailto:kokaramc at bellsouth.net]
> Sent: Friday, April 07, 2006 2:47 PM
> To: Trauma &amp; Critical Care mailing list
> Subject: Re: Re: Clamp the the chest tube in an EMS placed chest tube
>
>
> " ...for every 500ml of blood out of the chest tube, mortality
significantly
> increases..."
>
> Then for crying out loud, what are you letting all that blood out for?
:]
>
> " ...(Prehospital EMS) cant totally verify a PTX/HTX without an xray... "
>
> Waitwaitwait -- you recommend an x-ray before treating tension
pneumothorax?
> That's the only indication for prehospital thoracostomy, at least where I
> work.
>
> " ...and we sort of see enough PTX already caused by unnecessary needle
> decompressions in the field."
>
> Honest?  What are your sort of numbers?
>
> I admit I've seen a few unjustifiable needlings; but I can't recall a
> significant needle-related injury -- certainly nothing to force to
> eliminating the option.  In rural America, tension pneumo isn't an injury
> which tolerates neglect.
>
>
> Pret Bjorn, RN
> Bangor, ME USA
> --
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Clamp the the chest tube in an EMS placed chest tube