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Clamp the the chest tube in an EMS placed chest tube

akella chendrasekhar achendra at aol.com
Sat Apr 8 23:01:50 BST 2006


Doesn't this come under the scoop and run vs stay and play argument ? I
recall that at least 1 paper out of canada showed that patients did better
overall when scoop and run was used. while I think there may be rare
exceptions, I think better EMS care would be to get the patients to the
trauma surgeons' hands.
AChendrasekhar MD
----- 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 & 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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