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Tue Sep 16 20:06:00 BST 2008

That the "classic" signs are very inconsistent has been known for long time. I believe this was published in the first edition of Prehospital trauma Life Support PHTLS (1983)
Typed by the thumbs of
Norman on his BlackBerry 

Norman McSwain, MD
Tulane Univ Surgery
504 988-5111

----- Original Message -----
From: trauma-list-bounces at trauma.org <trauma-list-bounces at trauma.org>
To: Trauma &amp <trauma-list at trauma.org>
Sent: Tue Sep 16 13:53:24 2008
Subject: RE: Needle Decompression

Several posts on this thread have mentioned the 'classic' signs of tension pneumothorax. However there is a very good paper from the Emergency Medicine Journal in 2005 that should make you rethink and question. See:

Leigh-Smith S, Harris T. Tension pneumothorax—time for a rethink?
EMJ 2005;22:8–16.

What SImon and Tim showed was that 'classic' signs of tension pneumothorax are based on operative experience in an anaesthetised patient, where compensatory mechanisms have been reduced. In the non-anaesthetised patient there may be a number of compensatory mechanisms which means that the 'classic' signs may well not be present. My experience is that in a non-anaesthetised patient the 'classic' signs of tension pneumothorax only occur periarrest.

On the issue of 'does field needle thorocostomy work?' my experience is yes, but only very occasionally. It is certainly not as important an intervention as some prehospital trauma courses make out.

Tim Coats.
Professor of Emergency Medicine.
Leicester University, UK.

-----Original Message-----
From: McSwain, Norman E Jr. [mailto:nmcswai at tulane.edu]
Sent: Tue 9/16/2008 4:14 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Needle Decompression

See my comments from the two previous postings this morning. I would
only add that I have used it several times in the field myself with
apparent success. I say apparent because there were no radiographs to
prove a anatomical pathophysiological improvement. General improvement
in the patient's condition that made me believe that something had been
accomplished by it

Norman

Norman McSwain Jr, MD FACS
Trauma Director Charity Hospital
Professor of Surgery
Tulane University School of Medicine
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of kmattox at aol.com
Sent: Tuesday, September 16, 2008 9:23 AM
To: Trauma &amp; Critical Care mailing list
Subject: Re: Needle Decompression

I for one have never been impressed, nor seen real benefit from needle
decompression of the chest.   

K

------Original Message------
From: Dr Ross Hofmeyr
Sender: trauma-list-bounces at trauma.org
To: 'Trauma &amp; Critical Care mailing list'
ReplyTo: Trauma &amp; Critical Care mailing list
Sent: Sep 16, 2008 9:04 AM
Subject: RE: Needle Decompression

> You put 
> in in for proper indications ( decreased breath sounds, 
> decreased oxygenation) then is doing its job allowing the 
> lung to expand (blood or air they both can compress the 
> lung).

*Screeches to halt*

Holdonamminit - how, pray tell, does a cannula in the chest help the
lung
expand?  Do you mean a cannula PLUS non-return valve of some form?

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