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Clamp the the chest tube?

Ben Reynolds aneurysm_42 at yahoo.com
Sun Apr 9 00:48:00 BST 2006


Though no one has brought it up, I'm not sure why
people would bristle at the suggestion.

Of all the prehospital interventions we've talked
about thus far (intubation, needle decompression,
chest tubes, etc.) the one thing we HAVEN'T discussed
which has been almost UNIVERSALLY shown to be
associated with IMPROVED outcomes in the critically
injured is RAPID transport to a trauma center.

Unfortunately, it's not a topic which generates the
same sort of zeal or passion as intubation does.

Ben Reynolds, PA-C
Pittsburgh, PA
 
--- "J.A. Terranson" <measl at mfn.org> wrote:

> 
> So, are you proposing we go back to "Scoop and Run"?
> 
> 
> On Sat, 8 Apr 2006 docrickfry at aol.com wrote:
> 
> > Ahhhh...this argument always manages to rear its
> ugly head at some
> > point-- "Well, you know, evidence is fine,
> data-based medicine is fine,
> > until, that is, that is fails to support something
> that I just want to
> > do--then....MY own imagination and what I think
> sounds logical prevails"
> > Remember just 250 years ago this same argument was
> used for
> > bloodletting--perfectly logical to everybody, lets
> out the evil humors,
> > plenty of anecdotal cases of how people suddenly
> felt better, etc--who
> > needs data for such OBVIOUSLY beneficial
> intervention?  Then the data
> > came out, and guess what--not only no benefit, but
> it KILLED!  Same with
> > electro-shock Rx, frontal lobotomy--without a QA
> process applied, any
> > interventio is DANGEROUS until PROVEN
> otherwisw--why?  Because THAT, not
> > the opposite, is what is SAFEST for the patient.
> And we think witch
> > doctors were only a thing of the past..... ERF
> >
> > -----Original Message-----
> > From: Mike MacKinnon <mmackinnon at cox.net>
> > To: Trauma & Critical Care mailing list
> <trauma-list at trauma.org>
> > Sent: Fri, 7 Apr 2006 20:25:42 -0700
> > Subject: Re: Clamp the the chest tube?
> >
> >
> > Hey Dr. KM
> >
> >
> >
> > No data to my knowledge. However, just because
> something hasn't been studied
> > doesn't mean it has no empirical benefit (i.e.:
> the classic parachute
> > example).
> >
> >
> >
> > The procedure is utilized in air med for the same
> reasons (more stringent I
> > would suggest) as in the trauma room. Patient in
> extremis with clear chest
> > tube indication and long transport times. I can
> tell you, no more than 1-2
> > of these are done a year at my service and
> everything done is reviewed by
> > our 4 med directors and the receiving trauma
> surgeon. While there is no data
> >  I would suggest that with those two groups in
> agreement that the patient
> > needed a chest tube and it was justified that
> there is oversight and control
> > in regards to such a high risk procedure.
> >
> >
> >
> > Really, are you suggesting you need a peer
> reviewed study to show indication
> > for a procedure that is a "no brainer" and
> clinically driven in the trauma
> > room? The indications for air med are few and far
> between for chest tubes
> > (much less than in the trauma room).
> >
> >
> >
> > In anycase, here are three studies which I found
> after a quick search.
> >
> >
> >
> > Prehosp Emerg Care. 2005 Apr-Jun;9(2):191-7.
> >
> >
> >
> >
> >
> > The safety and efficacy of prehospital needle and
> tube thoracostomy by
> > aeromedical personnel.
> >
> >
> >
> > Davis DP, Pettit K, Rom CD, Poste JC, Sise MJ,
> Hoyt DB, Vilke GM.
> >
> >
> >
> > Department of Emergency Medicine, UCSD, San Diego,
> CA 92103, USA.
> > davismd at cox.net
> >
> >
> >
> > BACKGROUND: Aeromedical crews routinely use needle
> thoracostomy (NT) and
> > tube thoracostomy (TT) to treat major trauma
> victims (MTVs) with potential
> > tension pneumothorax; however, the efficacy of
> prehospital NT and TT is
> > unclear. OBJECTIVES: To explore the efficacy of
> aeromedical NT and TT in
> > MTVs. METHODS: A retrospective chart review was
> performed using prehospital
> > medical records and the county trauma registry
> over a seven-year period. All
> > MTVs undergoing placement of NT or TT by
> aeromedical personnel were included
> >  patients with incomplete data were excluded.
> Descriptive statistics were
> > used to report the incidence of air release,
> clinical improvement (improved
> > breath sounds or compliance if intubated,
> decreased dyspnea if nonintubated)
> >  and vital signs improvements (systolic blood
> pressure [SBP] increase to =90
> > mm Hg or increase by 5 mm Hg if < 90 mm Hg; heart
> rate improvement to 60-100
> > beats/min, increase by 10 beats/min if < 60 BPM,
> or decrease by 10 beats/min
> > if > 100 beats/min; oxygen saturation increase if
> < 95%) for both NT and TT
> > as documented in prehospital medical records.
> Survival and improvement in
> > SBP based on trauma registry data were recorded
> for patients stratified by
> > initial SBP. RESULTS: A total of 136 procedures
> (89 NTs and 47 TTs) in 81
> > patients were identified using prehospital medical
> records over a four-year
> > period. Response rates to NT (60% overall, 32%
> vital signs) and TT (75%
> > overall, 60% vital signs) were high. Vital signs
> improvements were observed
> > more often in patients with a pulse and in
> nonintubated patients. A total of
> > 168 patients were identified in the trauma
> registry over the seven-year
> > study period. Normalization of SBP was observed in
> two-thirds of patients
> > with a field SBP = 90 mm Hg and one-third of
> patients in whom field SBP
> > could not be obtained. A small but significant
> proportion of patients
> > undergoing prehospital NT and TT, including some
> with prehospital
> > hypotension and high injury severity, survived to
> hospital discharge. The
> > incidence of complications was low. CONCLUSIONS:
> Aeromedical crews appear to
> > appropriately select MTVs to undergo field NT or
> TT. A low incidence of
> > complications and a small but significant group of
> unexpected survivors
> > support continued use of this procedure by
> aeromedical personnel.
> >
> >
> >
> > J Emerg Med. 1995 Mar-Apr;13(2):155-63.
> >
> >
> >
> >
> >
> > Prehospital needle aspiration and tube
> thoracostomy in trauma victims: a
> > six-year experience with aeromedical crews.
> >
> >
> >
> > Barton ED, Epperson M, Hoyt DB, Fortlage D, Rosen
> P.
> >
> >
> >
> > Department of Emergency Medicine, University of
> California, San Diego
> > Medical Center 92013-8676, USA.
> >
> >
> >
> > The use of prehospital tube thoracostomy (TT) for
> the treatment of suspected
> > tension pneumothorax (TPtx) in trauma patients is
> controversial. A study is
> > presented that reviews a 6-year experience with
> the 
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