penetrating posterior torax injury continued

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On 11/1/06, Robert Smith <rfsmithmd at comcast.net> wrote:
>
> Never the less, going straight to the trauma center was the patient's only
> and best chance at survival. This is one of the most difficult things to
> convince people of when implementing a trauma system. The shortest route
> to
> definitive acute care is best. There is no point in driving the patient
> someplace where the injury cannot be meaningfully addressed. There is also
> no point in trying to provide any "treatment" to seriously injured
> patients
> in the pre-hospital setting.
>
> Rob


But had this been a "simple" tension pneumothorax, Dr. van der Kleyn's
facility would be the best destination, seeing that they were able to place
the chest tube. It was the jump to thoracotomy that overwhelmed them. How do
you formulate a practical triage logarithm that distinguishes between the
two?

I think it is unfair to expect a minimally trained crew to eyeball the
difference between "needs a chest tube" and "needs a thorocotomy" unless the
theory is you send the tension pneumo on a 40 min road trip with a nasal
cannula in case they need surgical intervention.

Sometimes the answer is "her injuries were beyond what we could handle"
which happens in rural Spain just as it happens in urban USA.

jed

jed peterson rn

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