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Sat Apr 8 23:01:36 BST 2006

Of course, since he was intubated (and by your own description may not have
needed that, maybe) then he was probably getting positive pressure
ventilation which probably contributed to his worsening tension.

Andrew

----- Original Message ----- 
From: "oded private" <tangentcarrot at hotmail.com>
To: <trauma-list at trauma.org>
Sent: Saturday, April 08, 2006 5:54 PM
Subject: Re: Clamp the the chest tube in an EMS placed chest tube

>
> I have heard of a case that may qulify. It was presented to us by a trauma
> surgeon. who was not part of it.
>
> >From what I remember (It was about two years ago):
> Young man,  shot in the neck (assualt rifle). Intubated (why? expanding
> hematoma/low GCS. Don't remember. Anyhow, O2 Sat. was good before
> intubation- that I do remember) by the first crew, than the tube pulled
out,
> later attempts by aircrew failed, so they went to cricothyroidotomy, and
it
> all took quite a long time. Being so busy with his A, they weren't to
> vigilant about his B and C deteriorating, and once the airway was secured
> they took off, he died enroute/in the hospital (not sure). Post mortem CT
> showed large collection of interpleural air and a mediastinal shift.
> Again- I'm not sure about the details, but the point remains. You might
take
> it to the other extreme- with no field managment in the first place, maybe
> he would have made to the hospital soon enough to be chest tubed in trauma
> room (I think the time it would take him to get there "scoop&run" style
> would be 35-60 minutes from injury)
>
>
> >From: KMATTOX at aol.com
> >Reply-To: "Trauma &amp; Critical Care mailing list"
> ><trauma-list at trauma.org>
> >To: trauma-list at trauma.org
> >Subject: Re: Clamp the the chest tube in an EMS placed chest tube
> >Date: Sat, 8 Apr 2006 16:39:52 EDT
> >
> >
> >In a message dated 4/8/2006 1:47:33 P.M. Central Standard Time,
> >Krin135 at aol.com writes:
> >
> >Then you  and Rick will be willing to testify Pro Bono for the  defense
if
> >an
> >
> >outlying trauma case with a suspicious chest injury does NOT  get a
chest
> >tube
> >by an appropriately trained crew and the patient dies  enroute  to the
> >receiving trauma facility, having bypassed one or  more small town
> >facilities (with
> >ED docs who have a better  armamentarum available than the crew)  which
are
> >NOT
> >trauma  centers?
> >
> >
> >
> >I would be happy to review such a case, if and when such a case is
produced
> >and it falls into the data that you cite.   Quite honestly, I have not
> >seen
> >or heard of such a case in military or civilian practice in the past
> >several
> >decades.   I HAVE seen a significant number of IATROGENIC (and  even
FATAL)
> >complications caused by such insertion if needles and tubes in the
> >ambulance,
> >helicopter, and non trauma center personnel.
> >
> >k
> >--
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Clamp the the chest tube in an EMS placed chest tube