Needle Decompression

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The problem with tracheal deviation is that it has no predictive value either way.  It is just as easy to convince yourself that tracheal deviation is present in the absence of pneumo (false positive)as it is to miss it when pneumo is present (false negative).  IMV tracheal deviation is a bad sign, too subjective and can't be relied on.  I don't teach it any more.
 
John
 
 
Dr John L Holmes Director Emergency Medicine
Mater Adult Hospital
Brisbane, Australia
 
 



> Subject: Re: Needle Decompression> Date: Wed, 17 Sep 2008 10:26:32 -0500> From: nmcswai at tulane.edu> To: trauma-list at trauma.org> > Tracheal deviation is important IF present and detectable. The problem is (as all the trauma surgeons know) the trachea is bound tightly to the spine in the neck (not in the chest as much) therefore when a large pneumothoerax is present and there is shift of the mediastinum and the trachea in the chest but not as much or as easily identifed in the neck. It is good when present but unreliable when absent.> 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; Critical Care mailing list <trauma-list at trauma.org>> Sent: Wed Sep 17 08:22:58 2008> Subject: Re: Needle Decompression> > Fair enough. To be sure, I did not mean to imply that assessing for > tracheal deviation has no value.> > LT> > Dr Ross Hofmeyr wrote:> > I agree, but how do you distinguish between cardiac tamponade and tension> > pneumo in a patient in extremis with a praecordial stab wound and> > ipsilateral pneumothorax? Sure, you can do a 'trial' needle decompression,> > but tracheal deviation will make the call, if present.> > > > > >> It doesn't take long, but it's a late sign. I've never seen > >> it in a patient not in extremis. > >>> >> LT> >>> >> Sent from my Verizon Wireless BlackBerry> >>> >> -----Original Message-----> >> From: "Dr Ross Hofmeyr" <wildmedic at gmail.com>> >>> >> Date: Wed, 17 Sep 2008 11:50:12> >> To: 'Trauma &amp; Critical Care mailing list'<trauma-list at trauma.org>> >> Subject: RE: Needle Decompression> >>> >>> >> I must be missing something here - what takes so long when > >> checking for> >> tracheal deviation? It's about a 5-second examination.> >>> >> R.> >>> late sign and demonstrated that looking for the deviation > >>> wasted time and aided in the practitioner loosing focus of > >>> the treatable injuries. Maybe it is time for main stream EMS > >> --> >> trauma-list : TRAUMA.ORG> >> To change your settings or unsubscribe visit:> >> http://www.trauma.org/index.php?/community/> >> --> >> trauma-list : TRAUMA.ORG> >> To change your settings or unsubscribe visit:> >> http://www.trauma.org/index.php?/community/> > > > --> > trauma-list : TRAUMA.ORG> > To change your settings or unsubscribe visit:> > http://www.trauma.org/index.php?/community/> > > > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/

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