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Wed Sep 17 12:33:54 BST 2008

I haven't read the paper in question, but I will try and get my hands on it.

In my previous post I was doing mostly front-room trauma work, including a
6-month stint in an area with almost unbelievable levels of violent trauma -
it would not be unusual to do 10-15 intercostal drains in a 12-hour weekend
shift.  The greater majority of these were for chest stabs.  Often, we were
without x-ray facilities, so many of these drains were based on clinical
findings only.  I've seen literally hundreds of pneumo- and haemothoraces in
a short time, and only had to decompress a chest a handful of times.
HOWEVER, I must respectfully disagree with those who suggest that tracheal
deviation is not clinically palpable.  I agree that it is a late sign, and
not a pre-requisite to making the diagnosis, but it does occur and when
combined with the other symptoms is unmistakable.

On the subject of paramedics and percussion - I've worked pre-hospital, and
I understand the difficulties, BUT there are times when it is perfectly
feasible.  That an incredibly useful method of examination is getting scant
mention in paramedic texts is a travesty.

R/

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