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Clamp the the chest tube?

Andrew J Bowman sumieb at compuserve.com
Sun Apr 9 21:17:33 BST 2006


How can one obtain a copy of McSwain's Scudder oration?

I cannot find it on the web, just references that he gave the presentation.

Andrew

----- Original Message ----- 
From: <docrickfry at aol.com>
To: <trauma-list at trauma.org>
Sent: Sunday, April 09, 2006 4:00 PM
Subject: Re: Clamp the the chest tube?


>
> In that case you in New York are quite out of touch with the current
published standards--see PHTLS and Norm McSwain's Scudder Oration in Truama
from 3 years ago--although there is room for a variety of prehospital
interventions, none of these should ever delay the rapid transport of a
patient to the nearest appropriate hospital, which remains the most
important principle of prehospital trauma management.  There is no place for
any time in the field for an injured patient except extrication
> ERF
>
> -----Original Message-----
> From: J.A. Terranson <measl at mfn.org>
> To: Trauma &amp; Critical Care mailing list <trauma-list at trauma.org>
> Sent: Sun, 9 Apr 2006 14:14:59 -0500 (CDT)
> Subject: Re: Clamp the the chest tube?
>
>
>
> On Sat, 8 Apr 2006 docrickfry at aol.com wrote:
>
> > Please refresh--when did we ever leave it?
>
> While i can't speak to your neck of the woods, in New York we left this
> behind in the late '80s.  In fact, until the NYFD borged our EMS, our
> EMT-Ps (and often our "EMTPYs" [awful emts] were pretty close to actually
> practicing independent medicine.  Where are *you* that scoop and run is
> still the norm?
>
>
> > ERF
> >
> > -----Original Message-----
> > From: J.A. Terranson <measl at mfn.org>
> > To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
> > Sent: Sat, 8 Apr 2006 12:56:50 -0500 (CDT)
> > Subject: Re: Clamp the the chest tube?
> >
> >
> >
> > 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 use of needle
catheter
> > > aspiration (NA) and chest tubes performed in the field by air medical
> > > personnel. Prehospital flight charts and hospital records from 207
trauma
> > > patients who underwent one or both of these procedures in the field
were
> > > retrospectively reviewed. The clinical indications used to determine
> > > treatment are presented for both procedures. Improvement in clinical
status
> > > of patients observed by flight personnel were similar for both
treatment
> > > groups (54% for NA, 61% for TT). Thirty-two (38%) of the TT patients
had
> > > failed NA attempts prior to chest tube placement. Average time on
scene (T.O
> > > S.) was significantly greater for the TT group (25.7 min versus 20.3
min for
> > > NA group). Fewer patients were pronounced dead on arrival (D.O.A.)
with TT
> > > treatment compared to NA alone (7% versus 19%, respectively). Injury
> > > severity scores, number of hospital complications, length of stay
(L.O.S.),
> > > and total hospital costs were not different between the two groups.
There
> > > were no cases of lung damage or empyema formation associated with
> > > prehospital TT treatment. Overall mortality was similar for both
groups.
> > > >From these data, we conclude that NA is a relatively rapid
intervention in
> > > the treatment of suspected TPtx in the prehospital setting; however,
TT is
> > > an effective adjunct for definitive care without increasing morbidity
or
> > > mortality. A better understanding of the physiology of intrapleural
air
> > > masses is needed to determine the most effective decompression
requirements
> > > prior to aeromedical transport.
> > >
> > >
> > >
> > > J Trauma. 2005 Jul;59(1):96-101.
> > >
> > >
> > >
> > > Prehospital chest tube thoracostomy: effective treatment or additional
> > > trauma?
> > >
> > >
> > >
> > > Spanjersberg WR, Ringburg AN, Bergs EA, Krijen P, Schipper IB.
> > >
> > >
> > >
> > > Department of General Surgery and Traumatology, University of
Rotterdam,
> > > Erasmus Medical Center, The Netherlands.
> > >
> > >
> > >
> > > BACKGROUND: The use of prehospital chest tube thoracostomy (TT)
remains
> > > controversial because of presumed increased complication risks. This
study
> > > analyzed infectious complication rates for physician-performed
prehospital
> > > and emergency department (ED) TT. METHODS: Over a 40-month period, all
> > > consecutive trauma patients with TT performed by the flight physician
at the
> > > accident scene were compared with all patients with TT performed in
the
> > > emergency department. Bacterial cultures, blood samples, and thoracic
> > > radiographs were reviewed for TT-related infections. RESULTS:
Twenty-two
> > > patients received prehospital TTs and 101 patients received ED TTs.
Infected
> > > hemithoraces related to TTs were found in 9% of those performed in the
> > > prehospital setting and 12% of ED-performed TTs (not significant).
> > > CONCLUSION: The prehospital chest tube thoracostomy is a safe and
lifesaving
> > > intervention, providing added value to prehospital trauma care when
> > > performed by a qualified physician. The infection rate for prehospital
TT
> > > does not differ from ED TT.
> > >
> > >
> > >
> > > Mike M.
> > >
> > >
> > >
> > > -------Original Message-------
> > >
> > >
> > >
> > > From: KMATTOX at aol.com
> > >
> > > Date: 04/07/06 20:02:20
> > >
> > > To: trauma-list at trauma.org
> > >
> > > Subject: Re: Clamp the the chest tube?
> > >
> > >
> > >
> > >
> > >
> > > In a message dated 4/7/2006 10:00:15 P.M. Central Standard Time,
> > >
> > > mmackinnon at cox.net writes:
> > >
> > >
> > >
> > >
> > >
> > > Happens all the time Dr. Mattox. Long transport times where  patients
are
> > >
> > > severly injured and need a completely justifiable chest  tube.
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > >
> > > True true and unrelated.    Show me the  data.   I know of no good
data
> > > which
> > >
> > > has been peer reviewed by the  Trauma service in critique of flight
services
> > >
> > >
> > >   Flight services  procedures are among the most out of control of any
in
> > >
> > > medicine.
> > >
> > >
> > >
> > > k
> > >
> > > --
> > >
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> > >
> >
> >
>
> -- 
> Yours,
>
> J.A. Terranson
> sysadmin at mfn.org
> 0xBD4A95BF
>
>
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