List Archives

Thu Sep 18 14:59:11 BST 2008

What was the question with ems and needle decompression, again?? Forgot after 3 days of this. I am so confused now,  with everyone's "answer".  Can someone please just  go over s/s and  appropriate tx.  I feel like I just un-learned a lot of stuff after reading all this. 

Thanks

Angela, 
confused, RN, BSN :)

----------------------------------------
> From: trauma-list-request at trauma.org
> Subject: trauma-list Digest, Vol 63, Issue 30
> To: trauma-list at trauma.org
> Date: Thu, 18 Sep 2008 12:00:09 +0100
> 
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> 
> Today's Topics:
> 
>    1. RE: Federal Government Role for Ike (Robert F. Smith)
>    2. Re: Needle Decompression (Larry Torrey)
>    3. RE: Needle Decompression (Dr Ross Hofmeyr)
>    4. Re: Needle Decompression (Larry Torrey)
>    5. Re: Needle Decompression (Larry Torrey)
>    6. Re: Needle Decompression (McSwain, Norman E Jr.)
>    7. SV: Needle Decompression (Frank ?stergaard Hansen)
>    8. RE: [CCM-L] ??  DMAT "Military" hospital and/or clinic
>       (Ruy Cabello-Pasini)
>    9. RE: [CCM-L] ??  DMAT "Military" hospital and/or clinic
>       (McSwain, Norman E Jr.)
>   10. Re: SV: Needle Decompression (Larry Torrey)
>   11. RE: Needle Decompression (John Holmes)
> 
> 
> ----------------------------------------------------------------------
> 
> Message: 1
> Date: Wed, 17 Sep 2008 08:22:53 -0400
> From: "Robert F. Smith" 
> Subject: RE: Federal Government Role for Ike
> To: "'Trauma & Critical Care mailing list'"
> 	
> Message-ID: 
> Content-Type: text/plain;	charset="us-ascii"
> 
> Jeff,
> 
> Is that "broadly not true" as in "you lying sack"? I bow to your expertise
> and experience. Perhaps I am speaking just of my state. Coordination would
> be difficult in this case because there is no one at the state level
> responsible for trauma and there is not currently a trauma program. I would
> say that in conversations with people like Rick Frykberg and Ron Gross my
> impression has been that there is a dramatically disproportionate Federal
> response in "Preparedness" toward bioterrorism rather than trauma. Given
> what I'd seen here, I'd assumed there was more silo building going on,
> rather than building of local infrastructure and coordination.
> 
> Rob Smith
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Jeffery Hammond
> Sent: Monday, September 15, 2008 5:01 PM
> To: 'Trauma & Critical Care mailing list'
> Subject: RE: Federal Government Role for Ike
> 
> This is broadly not true. Perhaps the trauma system is not involved in your
> states, but don't extrapolate this nationally. 
> 
> Health care, especially non-BT trauma care, can be an after thought if we
> let it. State and county OEMs will tend to focus on police, fire and first
> response issues. Public health may tend to forget about acute care
> provisions, just assuming we'll be there because we're always there. 
> 
> However, I can say that we in NJ have a good realtionship between our Trauma
> Center Council and state emergency planners. Not perfect, and a work in
> progress, but good. You have to work at it.
> 
> Jeff Hammond 
> 
> Jeffrey Hammond MD, MPH
> New Brunswick, NJ
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Robert F. Smith
> Sent: Monday, September 15, 2008 3:36 PM
> To: 'Trauma & Critical Care mailing list'
> Subject: RE: Federal Government Role for Ike
> 
> Exactly. And with all the money spent preparing for terrorist events, none
> of the planning and/or organization seems to involve trauma centers.
> 
> Rob Smith
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of KMATTOX at aol.com
> Sent: Monday, September 15, 2008 1:59 PM
> To: trauma-list at trauma.org
> Subject: Re: Federal Government Role for Ike
> 
>  
> In a message dated 9/15/2008 12:57:05 P.M. Central Daylight Time,
> gflores911 at gmail.com writes:
> 
> Who is  the liaison between the trauma center and the state's emergency
> operation's  center (EOC)?
> 
> 
> It does NOT EXIST, despite multiple requests.   It is all  LOCAL, if at all.
>  
> k
> 
> 
> 
> **************Psssst...Have you heard the news? There's a new fashion blog, 
> plus the latest fall trends and hair styles at StyleList.com.      
> (http://www.stylelist.com/trends?ncid=aolsty00050000000014)
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> 
> 
> ------------------------------
> 
> Message: 2
> Date: Wed, 17 Sep 2008 12:28:32 +0000
> From: "Larry Torrey" 
> Subject: Re: Needle Decompression
> To: "Trauma & Critical Care mailing list" 
> Message-ID:
> 	
> 	
> Content-Type: text/plain
> 
> 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" 
> 
> Date: Wed, 17 Sep 2008 11:50:12 
> To: 'Trauma & Critical Care mailing list'
> 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
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> 
> ------------------------------
> 
> Message: 3
> Date: Wed, 17 Sep 2008 12:55:38 -0000
> From: "Dr Ross Hofmeyr" 
> Subject: RE: Needle Decompression
> To: "'Trauma & Critical Care mailing list'"
> 	
> Message-ID: 
> Content-Type: text/plain;	charset="US-ASCII"
> 
> 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" 
>> 
>> Date: Wed, 17 Sep 2008 11:50:12
>> To: 'Trauma & Critical Care mailing list'
>> 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
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> 
> 
> 
> ------------------------------
> 
> Message: 4
> Date: Wed, 17 Sep 2008 09:22:58 -0400
> From: Larry Torrey 
> Subject: Re: Needle Decompression
> To: "Trauma & Critical Care mailing list" 
> Message-ID: 
> Content-Type: text/plain; charset=ISO-8859-1; format=flowed
> 
> 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" 
>>>
>>> Date: Wed, 17 Sep 2008 11:50:12
>>> To: 'Trauma & Critical Care mailing list'
>>> 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
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>>> trauma-list : TRAUMA.ORG
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>>> 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/
>> 
> 
> 
> 
> ------------------------------
> 
> Message: 5
> Date: Wed, 17 Sep 2008 09:24:40 -0400
> From: Larry Torrey 
> Subject: Re: Needle Decompression
> To: "Trauma & Critical Care mailing list" 
> Message-ID: 
> Content-Type: text/plain; charset=UTF-8; format=flowed
> 
> *applause*
> 
> The key to quality EMS is quality physician leadership.
> 
> LT
> 
> McSwain, Norman E Jr. wrote:
>> Sorry but I must object. This is not a problem with the technique is
>> a problem of lack of physician direction and control over the EMS
>> service. THIS A PHYSICIAN FAULT NOT AN EMS FAULT. The medical
>> director should provide more discipline and teaching in those
>> services where use of needle decompression OR ANY technique is out of
>> control or used inappropriately. Patient care in jeopardy
>> 
>> 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 Andrew Bowman 
>> Sent: Tuesday, September 16, 2008 7:27 PM To: Trauma & Critical
>> Care mailing list Cc: Trauma & Critical Care mailing list 
>> Subject: Re: Needle Decompression
>> 
>> Some EMS services are more out of control than others. The last one I
>>  saw come in the patient did nor even gave a pneumo. Fortunately the
>>  needle failed to reach the pleural space.
>> 
>> Typed by my index finger and sent from my iPhone!!
>> 
>> Andrew J. Bowman Acute Care Nurse Practitioner Trauma Nurse
>> Specialist Emergency Department Registered Nurse Paramedic Witham
>> Health Services Lebanon, Indiana 765-485-8510 (Work) 765-426-4189
>> (Cell)
>> 
>> On Sep 16, 2008, at 7:58 PM, Larry Torrey 
>> wrote:
>> 
>>> Do you see a lot of these procedures?  I work in a teaching
>>> hospital in a major US city, and see one, maybe two per year come
>>> in the door from EMS.
>>> 
>>> LT
>>> 
>>> MARK FORREST wrote:
>>>> Pre-hospital needle thoracocentesis is probably the most
>>>> over-used unnecessary skill in the EMS tool box. All to often we
>>>> see an RTC casualty with a minimal degree of respiratory
>>>> compromise 'needled just in case'!! Many of them have iatrogenic
>>>> problems related to this action However, I do agree with Tim,
>>>> that in some rare cases that I have seen, pre-hospital
>>>> throacocentesis (with a 14G cannulae) can be life saving. When it
>>>> has been necessary, I actually remember that the 'hiss' has been
>>>> genuinely loud, unlike the many innappropriate ones that I have
>>>> seen with little if any postive sign or improvment. As for
>>>> diagnosis, the last pre-hospital one that I decompressed was the
>>>> driver of a car in a high speed RTC who I was asked to see as he 
>>>> was very distressed with his breathing. From the backdoors of the
>>>>  ambulance I could see the hyperinflation, grossly unequal
>>>> movement of his chest and his oxygen saturation of 75% on high
>>>> flow oxygen! The paramedics actually heard the decompression
>>>> 'hiss' outside the ambulance. He rapidly stabilised and was
>>>> transported the short distance to hospital for an x-ray and a
>>>> drain. If you want to see 'real'clinical signs of tension then
>>>> try the ICU. When these patients tension on IPPV they have some
>>>> of the most barn door signs that you will ever see....including
>>>> mid-line shift, which I have never seen pre-hospital. Dr Mark
>>>> Forrest Consultant in Anaesthetics & Critical Care Medical 
>>>> Director of Cheshire Fire & Rescue Service Medical Director of
>>>> ATACC ----- Original Message ---- From: Robert Waddell II 
>>>>  To: "Trauma & Critical Care mailing
>>>> list"  Sent: Tuesday, 16 September, 2008
>>>> 8:11:16 PM Subject: Re: Needle Decompression Thanks Tim, I'll try
>>>> to get the paper.  Your comments have a greater volume than some
>>>> may see in that the classic signs, especially those listed in
>>>> most of the text, include deviated trachea.  I believe it was Lee
>>>> in the 80's who showed through a large post evaluation analysis
>>>> that tracheal deviation occurred in non-viable (dead) patients
>>>> and was an extremely 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 to re-think the "why we do what we do" and get back to
>>>> a stronger focus on the patient we're caring for and their
>>>> positive outcomes. Thanks again. Take care, Bob
>>>> bobwaddell at bresnan.net 307 920 2020 On Sep 16, 2008, at 12:53 PM,
>>>> Coats Tim - Professor of Emergency Medicine wrote:
>>>>> 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 & 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 & 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 & Critical Care 
>>>>> mailing list' ReplyTo: Trauma & 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? -- trauma-list :
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>>>> -- trauma-list : TRAUMA.ORG To change your settings or
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> 
> 
> 
> ------------------------------
> 
> Message: 6
> Date: Wed, 17 Sep 2008 10:26:32 -0500
> From: "McSwain, Norman E Jr." 
> Subject: Re: Needle Decompression
> To: 
> Message-ID:
> 	
> Content-Type: text/plain;	charset="UTF-8"
> 
> 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 
> To: Trauma & Critical Care mailing list 
> 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" 
>>>
>>> Date: Wed, 17 Sep 2008 11:50:12
>>> To: 'Trauma & Critical Care mailing list'
>>> 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
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>>> http://www.trauma.org/index.php?/community/
>> 
>> --
>> trauma-list : TRAUMA.ORG
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> 
> --
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> 
> ------------------------------
> 
> Message: 7
> Date: Wed, 17 Sep 2008 19:33:53 +0200
> From: Frank ?stergaard Hansen 
> Subject: SV: Needle Decompression
> To: "'Trauma & Critical Care mailing list'"
> 	
> Message-ID: 
> Content-Type: text/plain;	charset="iso-8859-1"
> 
> Hay list
> 
> The TCCC say the needle must bee 3.25 inch and 14-gauge,  2 1/2 inch as dr
> Mcswain says, it is not a new thing, know 3-4 studies don, whit US and CT,
> that all say the same thing, normal IV needle is to short.
> 
> EMJ had a good paper on tension PTX, a while back, take a look at that one.
> It was call "Tension pneumothorax?time for a re-think?" by S Leigh-Smith and
> T Harris. Send me at mail if you like I have it.
> 
> Frank Hansen
> 
> -----Oprindelig meddelelse-----
> Fra: McSwain, Norman E Jr. [mailto:nmcswai at tulane.edu] 
> Sendt: 16. september 2008 15:41
> Til: Trauma & Critical Care mailing list
> Emne: RE: Needle Decompression
> 
> If you are really in the chest then it should be left in place. However
> there is some good data from the Tactical Combat Casualty Care committee
> that many needles are NOT long enough to penetrate into the chest
> cavity. This is from some recent cadaver studies looking at the actual
> anatomy and length of the needles used. The new standard for the
> military developed by TCCC is that a 2 1/2 inch needle should be used to
> successfully accomplish decompression. The usual needle for IV access
> needle is 1 1/2 inches or shorter. 
> 
> 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 Sahaj Khalsa
> Sent: Monday, September 15, 2008 11:48 PM
> To: Trauma &, Critical Care mailing list
> Subject: Needle Decompression
> 
> Hello all,
> 
> Many thanks to all of those who have been keeping all of us updated
> about
> their situations during this horrible hurricane season.  I have lots of
> family in Houston so I felt like I had a more real and direct line to
> what
> was going on than the news, which was great.  Our thoughts and prayers
> are
> with all of you who are still recovering from all of the devastation.
> 
> So I am interested in the opinions of anybody on this list who cares to
> share them and has a few spare minutes...
> 
> I am a Paramedic and a paramedic instructor and we are trained that when
> we
> decompress a chest (usually with a 14 ga catheter) and get blood flow
> back,
> we should pull the catheter.  Why?
> 
> I have discussed this with a number of the ER docs that I work with and
> there is no real clear consensus.  Some of them say that I should leave
> the
> catheter in the chest as relieving the pressure is a good thing, whether
> that pressure is caused by blood or air.  However, most Paramedic
> textbooks
> advise us to pull it.
> 
> Assuming that I have put the dart in correctly (and have not hit the
> vessels
> in the chest wall), understanding that I do not have the capability of
> putting in a chest tube and that I am often times more than 60 minutes
> by
> ground from the nearest hospital with no alternative transport (helo)
> available, what is your opinion?
> 
> Any replies would be appreciated.
> 
> Sahaj Khalsa
> --
> trauma-list : TRAUMA.ORG
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> 
> 
> 
> 
> ------------------------------
> 
> Message: 8
> Date: Wed, 17 Sep 2008 11:35:59 -0700 (PDT)
> From: Ruy Cabello-Pasini 
> Subject: RE: [CCM-L] ??  DMAT "Military" hospital and/or clinic
> To: Trauma & Critical Care mailing list 
> Message-ID: 
> Content-Type: text/plain; charset=iso-8859-1
> 
> Dr McSwain and list
> 
> Sorry for jumping in so late on this but, I had the experience of learning a bit of your disaster response systems when I was sent to help on hurricane Katrina with the Mexican Army convoy that stayed at San Antonio 3 y ago.  First of all I know we were there only for political reasons (probably most of you do not know we were there, but we were)...  Yes our cooks helped feed some of the refugees from Katrina that were staying in shelters in the City and we attended the meetings or debriefings at the ICP.....  I was sent with 2 others to give medical support, of course I was really mad because of no coordination at all (We did not have any license to practice of course, and did not have the place to do it any way, we were only bringing first aid resources for our own troops)... but as I said before the really only purpose of our visit was political (that I found out later when all the nice pictures of our camp were taken and a lot of military, local,
>  state and federal authorities visiting and bringing medals, deplomas, etc....),  Any way I tried to get the best out of the situation and had the chance to meet Dr Ronald Stewart at the UTHSC trauma center, he is a GREAT person and host and, made us feel like at home (we only told our authorities we were coordinating efforts and had the chance to be away of the Texan heat in late summer by staying at the hospital, doing rounds, M&Ms meetings, visiting the library, etc).  It was in one of those visits that I had the chance to witness the Operation Center and, as explained to me by Dr Stewart, was the only one in the county and probably around the state of Texas.  What I saw was ONE administrator of EVERY hospital or trauma center from their county or regional level, sat there in one area of the library with a computer and a telephone directly connected with their hospital so at any moment the person in charge would know exactly the number of beds, ORs,
>  ERs spaces available and coordinate the medical assistance with better understanding of that particular point.  I have annexed an article I found where they show their system published in the Am J Surg. 
> Any comments?
> greetings
> 
> Ruy Cabello Pasini, MD
> Trauma Surgeon
> Hospital Central Militar
> MEXICO
> 
> Titre du document / Document title
> A regional medical operations center improves disaster response and inter-hospital trauma transfers. Discussion
> Auteur(s) / Author(s)
> EPLEY Eric E. (Commentateur (texte ?crit)) (1) ; STEWART Ronald M. (1 2 3) ; LOVE Preston (1 2) ; JENKINS Donald (4) ; SIEGWORTH Gina M. (5) ; BASKIN Toney W. (6) ; FLAHERTY Stephen (6) ; COCKE Robert (1) ; SHATNEY Clayton ;
> Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
> (1) The Southwest Texas Regional Advisory Council for Trauma, San Antonio, TX, ETATS-UNIS
> (2) The University of Texas Health Science Center at San Antonio, San Antonio, TX, ETATS-UNIS
> (3) The University Health System, San Antonio, TX, ETATS-UNIS
> (4) Wilford Hall Medical Center, San Antonio, TX, ETATS-UNIS
> (5) Greater San Antonio Area Hospital Council, San Antonio, TX, ETATS-UNIS
> (6) Brooke Army Medical Center, San Antonio, TX, ETATS-UNIS
> R?sum? / Abstract
> Background: Delays in both inter-hospital trauma transfers and disaster response are common. We hypothesized patient flow could be improved by formal adoption of systems that improve cooperation and communication. Methods: The regional trauma database of the Southwest Texas Regional Advisory Council for Trauma and the Regional Medical Operations Center (RMOC) database were queried to test the hypothesis. Results: A total of 9507 trauma patients were transferred. Medcom resulted in decreased transfer process times. The RMOC was activated during Hurricanes Katrina and Rita. During two 24-hour periods, the RMOC coordinated the inter-hospital transfer of 781 patients and the movement of thousands of evacuees and special needs patients. Conclusions: Medcom, an organized system combining a communications center with formal trauma center cooperation, improves patient flow and reduces trauma transfer times. The RMOC, based on the same principles of cooperation
>  and communication, allows for rapid transfer of hospitalized and special needs patients during disaster/mass casualty situations.
> Revue / Journal Title
> The American journal of surgery   ISSN 0002-9610   CODEN AJSUAB 
> Source / Source
> Congr?s
> Annual Meeting of the South Western Surgical Congress No58, Kauai, Hawa? , ETATS-UNIS (03/04/2006) 
> 2006, vol. 192, no 6 (201 p.)  [Document : 7 p.] (15 ref.), pp. 853-859 [7 page(s) (article)]
> Langue / Language
> Anglais
> Editeur / Publisher
> Elsevier, New York, NY, ETATS-UNIS  (1905) (Revue)
> Mots-cl?s anglais / English Keywords
> Treatment ; Surgery ; Cooperation ; Communication ; Planning ; Patient ; Human ; Lesion ; Wound ; Discussion ; Transfer ; Hospital ; Disaster ; Improvement ; Center ; Operation ; Disaster medicine ; Regional ; Trauma ;
> Mots-cl?s fran?ais / French Keywords
> Catastrophe ; Traitement ; Chirurgie ; Coop?ration ; Communication ; Planification ; Malade ; Homme ; L?sion ; Plaie ; Discussion ; Transfert ; H?pital ; Sinistre ; Am?lioration ; Centre ; Intervention ; M?decine catastrophe ; R?gional ; Traumatisme ;
> Mots-cl?s espagnols / Spanish Keywords
> Tratamiento ; Cirug?a ; Cooperaci?n ; Comunicaci?n ; Planificaci?n ; Enfermo ; Hombre ; Lesi?n ; Herida ; Discusi?n ; Transferencia ; Hospital ; Siniestro ; Mejora ; Centro ; Operaci?n ; Medicina cat?strofe ; Regional ; Traumatismo ;
> Mots-cl?s d'auteur / Author Keywords
> Trauma centers ; Wounds and injuries ; Patient transfer ; Disaster planning ; Regional medical systems ; Communication ; Cooperation ;
> Localisation / Location
> INIST-CNRS, Cote INIST : 5070, 35400014525522.0290
> 
> Copyright 2008 INIST-CNRS. All rights reserved
> Toute reproduction ou diffusion m?me partielle, par quelque proc?d? ou sur tout support que ce soit, ne pourra ?tre faite sans l'accord pr?alable ?crit de l'INIST-CNRS.
> No part of these records may be reproduced of distributed, in any form or by any means, without the prior written permission of INIST-CNRS.
> N? notice refdoc (ud4) : 18445437
> 
> 
> 
> --- On Mon, 9/15/08, McSwain, Norman E Jr.  wrote:
> 
>> From: McSwain, Norman E Jr. 
>> Subject: RE: [CCM-L] ??  DMAT "Military" hospital and/or clinic
>> To: "Trauma &" , "Trauma & Critical Care mailing list" 
>> Cc: coletta.barrett at ololrmc.com
>> Date: Monday, September 15, 2008, 2:07 AM
>> I would add one additional but very important thought. It is
>> what Dr Mattox and I have been saying but perhaps not too
>> clearly. The system that is currently in use is composed of
>> a bunch of silo's (Ken's term) all of which function
>> within their own silo and do not talk to those in other
>> silo's. or if they do communicate it is hours or days
>> later. This leads to frustration but most importantly it
>> leads to misuse of resources and lack of coordination. It
>> slows the progress of the management of the disaster at
>> hand.
>>  
>>  It would be like two surgeons in the same operating room
>> working on the same patient at the same time but working on
>> different sides of the abdomen without talking to each
>> other. Both trying to use the same instruments and telling
>> the anesthiologist to do different things to the patient
>> because they have different philosophies of resuscitation
>> and what is the best for the patient. Neither surgeon is the
>> leader but both are doing their own thing with no
>> coordination. One surgeon is much slower than the other (one
>> is a plastic surgeon who must make very meticulous
>> movements, is used to dealing with a very stable patient and
>> has plenty of time to think and centuplicate the next move,
>> and the other surgeon usually takes care of GunShotWounds
>> with a rapidly bleeding patient, who is very unstable, the
>> movements must be very quick and decisive. The patient
>> suffers.
>>  
>> That is exactly what is happening with disaster management.
>> There are a bunch of silo leaders who think that they are in
>> charge but do not understand the entire scope of the problem
>> and may not even know what is happening in the other silos.
>> None have the same training. Some are used to quick action
>> and others are used to planning for weeks before making a
>> move. Each has a different philosophy of disaster
>> management. There is no leadership. No one is in charge of
>> all of the silos, so each silo does its own thing. The
>> progress of the disaster flounders
>>  
>> Perhaps I am being too severe but I do not think so.
>>  
>>  
>>  
>> Norman
>>  
>> Norman McSwain MD
>> Trauma Director, Charity Hospital
>> Professor of Surgery, Tulane University
>> New Orleans LA
>> 504 988 5111
>> norman.mcswain at tulane.edu
>>  
>> 
>> ________________________________
>> 
>> From: trauma-list-bounces at trauma.org on behalf of Richard
>> Besserman, M.D., M.S., CHS-V
>> Sent: Sun 9/14/2008 7:26 PM
>> To: Trauma & Critical Care mailing list
>> Subject: Re: [CCM-L] ?? DMAT "Military" hospital
>> and/or clinic
>> 
>> 
>> 
>> Bob
>> 
>> As one potential after thought to another, I really
>> appreciate your
>> explanation.  I get it.  I recognize that the perspective
>> of the planners is
>> global (save as many lives as possible) and that could be
>> in conflict with a
>> narrower trauma mission.  These folks have a broad range of
>> non-trauma
>> issues to address.
>> 
>> I sense that the trauma community is far better motivated
>> than other
>> specialties in medicine to keep involved in disaster
>> issues.  I have great
>> faith in the value of leadership when fighting uphill
>> battles and am
>> impressed with the motivation and zeal I have seen so far.
>> Thanks again.
>> I'll sit back and listen for now.
>> 
>> Dick Besserman
>> 
>> 
>> On 9/14/08 4:55 PM, "ALS79 at aol.com"
>>  wrote:
>> 
>>> With all due respect Dr. Besserman, what you're
>> reading is the frustration on
>>> the part of trauma surgery experts who are tired of
>> having federal program
>>> proponents foisting their ideologies and administrivia
>> into local matters. To
>>> me, the entry point is those who stick their hands
>> into the chests, bellies
>>> and
>>> extremities of those with whom they are expected and
>> entrusted to protect,
>>> rather than professional planners in DC, who for the
>> most part have no "real
>>> world" experience in the mitigation of surgical
>> and medical emergencies -
>>> especially on a massive scale.
>>>
>>> What they are saying is that the system is vertically
>> integrated (top-down)
>>> along federal funding guidelines, and not constructed
>> around rational local
>>> needs and requirements based on resources and demand.
>> In fact, the medical
>>> community has been bypassed, and is considered by many
>> an afterthought.
>>> Property be
>>> damned, for my money, I want someone who can save my
>> life - even within the
>>> construct of the federal template. But, no one's
>> listening. Thus, these
>>> postings.
>>>
>>> Bob Kellow
>>>
>>>
>>> **************
>>> Psssst...Have you heard the news? There's a new
>>> fashion blog, plus the latest fall trends and hair
>> styles at StyleList.com.
>>>      
>>>
>> (http://www.stylelist.com/trends?ncid=aolsty00050000000014)
>>> --
>>> 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/
> 
> 
>       
> 
> 
> ------------------------------
> 
> Message: 9
> Date: Wed, 17 Sep 2008 13:46:19 -0500
> From: "McSwain, Norman E Jr." 
> Subject: RE: [CCM-L] ??  DMAT "Military" hospital and/or clinic
> To: "Trauma & Critical Care mailing list" 
> Message-ID:
> 	
> Content-Type: text/plain;	charset="iso-8859-1"
> 
> Thanks for the update. It is good to know that someone is doing it correctly. Actually information that is filtering out of Baton 
> Rouge is that their command center worked well. That is good to know
> 
> Norman
>  
> Norman McSwain MD
> Professor, Tulane School of Medicine
> Trauma Director, Charity Hospital Trauma Center
> norman.mcswain at tulane.edu
> 504 988 5111
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Ruy Cabello-Pasini
> Sent: Wednesday, September 17, 2008 1:36 PM
> To: Trauma & Critical Care mailing list
> Subject: RE: [CCM-L] ?? DMAT "Military" hospital and/or clinic
> 
> Dr McSwain and list
> 
> Sorry for jumping in so late on this but, I had the experience of learning a bit of your disaster response systems when I was sent to help on hurricane Katrina with the Mexican Army convoy that stayed at San Antonio 3 y ago.  First of all I know we were there only for political reasons (probably most of you do not know we were there, but we were)...  Yes our cooks helped feed some of the refugees from Katrina that were staying in shelters in the City and we attended the meetings or debriefings at the ICP.....  I was sent with 2 others to give medical support, of course I was really mad because of no coordination at all (We did not have any license to practice of course, and did not have the place to do it any way, we were only bringing first aid resources for our own troops)... but as I said before the really only purpose of our visit was political (that I found out later when all the nice pictures of our camp were taken and a lot of military, local,
>  state and federal authorities visiting and bringing medals, deplomas, etc....),  Any way I tried to get the best out of the situation and had the chance to meet Dr Ronald Stewart at the UTHSC trauma center, he is a GREAT person and host and, made us feel like at home (we only told our authorities we were coordinating efforts and had the chance to be away of the Texan heat in late summer by staying at the hospital, doing rounds, M&Ms meetings, visiting the library, etc).  It was in one of those visits that I had the chance to witness the Operation Center and, as explained to me by Dr Stewart, was the only one in the county and probably around the state of Texas.  What I saw was ONE administrator of EVERY hospital or trauma center from their county or regional level, sat there in one area of the library with a computer and a telephone directly connected with their hospital so at any moment the person in charge would know exactly the number of beds, ORs,
>  ERs spaces available and coordinate the medical assistance with better understanding of that particular point.  I have annexed an article I found where they show their system published in the Am J Surg. 
> Any comments?
> greetings
> 
> Ruy Cabello Pasini, MD
> Trauma Surgeon
> Hospital Central Militar
> MEXICO
> 
> Titre du document / Document title
> A regional medical operations center improves disaster response and inter-hospital trauma transfers. Discussion
> Auteur(s) / Author(s)
> EPLEY Eric E. (Commentateur (texte ?crit)) (1) ; STEWART Ronald M. (1 2 3) ; LOVE Preston (1 2) ; JENKINS Donald (4) ; SIEGWORTH Gina M. (5) ; BASKIN Toney W. (6) ; FLAHERTY Stephen (6) ; COCKE Robert (1) ; SHATNEY Clayton ;
> Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)
> (1) The Southwest Texas Regional Advisory Council for Trauma, San Antonio, TX, ETATS-UNIS
> (2) The University of Texas Health Science Center at San Antonio, San Antonio, TX, ETATS-UNIS
> (3) The University Health System, San Antonio, TX, ETATS-UNIS
> (4) Wilford Hall Medical Center, San Antonio, TX, ETATS-UNIS
> (5) Greater San Antonio Area Hospital Council, San Antonio, TX, ETATS-UNIS
> (6) Brooke Army Medical Center, San Antonio, TX, ETATS-UNIS
> R?sum? / Abstract
> Background: Delays in both inter-hospital trauma transfers and disaster response are common. We hypothesized patient flow could be improved by formal adoption of systems that improve cooperation and communication. Methods: The regional trauma database of the Southwest Texas Regional Advisory Council for Trauma and the Regional Medical Operations Center (RMOC) database were queried to test the hypothesis. Results: A total of 9507 trauma patients were transferred. Medcom resulted in decreased transfer process times. The RMOC was activated during Hurricanes Katrina and Rita. During two 24-hour periods, the RMOC coordinated the inter-hospital transfer of 781 patients and the movement of thousands of evacuees and special needs patients. Conclusions: Medcom, an organized system combining a communications center with formal trauma center cooperation, improves patient flow and reduces trauma transfer times. The RMOC, based on the same principles of cooperation
>  and communication, allows for rapid transfer of hospitalized and special needs patients during disaster/mass casualty situations.
> Revue / Journal Title
> The American journal of surgery   ISSN 0002-9610   CODEN AJSUAB 
> Source / Source
> Congr?s
> Annual Meeting of the South Western Surgical Congress No58, Kauai, Hawa? , ETATS-UNIS (03/04/2006) 
> 2006, vol. 192, no 6 (201 p.)  [Document : 7 p.] (15 ref.), pp. 853-859 [7 page(s) (article)]
> Langue / Language
> Anglais
> Editeur / Publisher
> Elsevier, New York, NY, ETATS-UNIS  (1905) (Revue)
> Mots-cl?s anglais / English Keywords
> Treatment ; Surgery ; Cooperation ; Communication ; Planning ; Patient ; Human ; Lesion ; Wound ; Discussion ; Transfer ; Hospital ; Disaster ; Improvement ; Center ; Operation ; Disaster medicine ; Regional ; Trauma ;
> Mots-cl?s fran?ais / French Keywords
> Catastrophe ; Traitement ; Chirurgie ; Coop?ration ; Communication ; Planification ; Malade ; Homme ; L?sion ; Plaie ; Discussion ; Transfert ; H?pital ; Sinistre ; Am?lioration ; Centre ; Intervention ; M?decine catastrophe ; R?gional ; Traumatisme ;
> Mots-cl?s espagnols / Spanish Keywords
> Tratamiento ; Cirug?a ; Cooperaci?n ; Comunicaci?n ; Planificaci?n ; Enfermo ; Hombre ; Lesi?n ; Herida ; Discusi?n ; Transferencia ; Hospital ; Siniestro ; Mejora ; Centro ; Operaci?n ; Medicina cat?strofe ; Regional ; Traumatismo ;
> Mots-cl?s d'auteur / Author Keywords
> Trauma centers ; Wounds and injuries ; Patient transfer ; Disaster planning ; Regional medical systems ; Communication ; Cooperation ;
> Localisation / Location
> INIST-CNRS, Cote INIST : 5070, 35400014525522.0290
> 
> Copyright 2008 INIST-CNRS. All rights reserved
> Toute reproduction ou diffusion m?me partielle, par quelque proc?d? ou sur tout support que ce soit, ne pourra ?tre faite sans l'accord pr?alable ?crit de l'INIST-CNRS.
> No part of these records may be reproduced of distributed, in any form or by any means, without the prior written permission of INIST-CNRS.
> N? notice refdoc (ud4) : 18445437
> 
> 
> 
> --- On Mon, 9/15/08, McSwain, Norman E Jr.  wrote:
> 
>> From: McSwain, Norman E Jr. 
>> Subject: RE: [CCM-L] ??  DMAT "Military" hospital and/or clinic
>> To: "Trauma &" , "Trauma & Critical Care mailing list" 
>> Cc: coletta.barrett at ololrmc.com
>> Date: Monday, September 15, 2008, 2:07 AM
>> I would add one additional but very important thought. It is
>> what Dr Mattox and I have been saying but perhaps not too
>> clearly. The system that is currently in use is composed of
>> a bunch of silo's (Ken's term) all of which function
>> within their own silo and do not talk to those in other
>> silo's. or if they do communicate it is hours or days
>> later. This leads to frustration but most importantly it
>> leads to misuse of resources and lack of coordination. It
>> slows the progress of the management of the disaster at
>> hand.
>>  
>>  It would be like two surgeons in the same operating room
>> working on the same patient at the same time but working on
>> different sides of the abdomen without talking to each
>> other. Both trying to use the same instruments and telling
>> the anesthiologist to do different things to the patient
>> because they have different philosophies of resuscitation
>> and what is the best for the patient. Neither surgeon is the
>> leader but both are doing their own thing with no
>> coordination. One surgeon is much slower than the other (one
>> is a plastic surgeon who must make very meticulous
>> movements, is used to dealing with a very stable patient and
>> has plenty of time to think and centuplicate the next move,
>> and the other surgeon usually takes care of GunShotWounds
>> with a rapidly bleeding patient, who is very unstable, the
>> movements must be very quick and decisive. The patient
>> suffers.
>>  
>> That is exactly what is happening with disaster management.
>> There are a bunch of silo leaders who think that they are in
>> charge but do not understand the entire scope of the problem
>> and may not even know what is happening in the other silos.
>> None have the same training. Some are used to quick action
>> and others are used to planning for weeks before making a
>> move. Each has a different philosophy of disaster
>> management. There is no leadership. No one is in charge of
>> all of the silos, so each silo does its own thing. The
>> progress of the disaster flounders
>>  
>> Perhaps I am being too severe but I do not think so.
>>  
>>  
>>  
>> Norman
>>  
>> Norman McSwain MD
>> Trauma Director, Charity Hospital
>> Professor of Surgery, Tulane University
>> New Orleans LA
>> 504 988 5111
>> norman.mcswain at tulane.edu
>>  
>> 
>> ________________________________
>> 
>> From: trauma-list-bounces at trauma.org on behalf of Richard
>> Besserman, M.D., M.S., CHS-V
>> Sent: Sun 9/14/2008 7:26 PM
>> To: Trauma & Critical Care mailing list
>> Subject: Re: [CCM-L] ?? DMAT "Military" hospital
>> and/or clinic
>> 
>> 
>> 
>> Bob
>> 
>> As one potential after thought to another, I really
>> appreciate your
>> explanation.  I get it.  I recognize that the perspective
>> of the planners is
>> global (save as many lives as possible) and that could be
>> in conflict with a
>> narrower trauma mission.  These folks have a broad range of
>> non-trauma
>> issues to address.
>> 
>> I sense that the trauma community is far better motivated
>> than other
>> specialties in medicine to keep involved in disaster
>> issues.  I have great
>> faith in the value of leadership when fighting uphill
>> battles and am
>> impressed with the motivation and zeal I have seen so far.
>> Thanks again.
>> I'll sit back and listen for now.
>> 
>> Dick Besserman
>> 
>> 
>> On 9/14/08 4:55 PM, "ALS79 at aol.com"
>>  wrote:
>> 
>>> With all due respect Dr. Besserman, what you're
>> reading is the frustration on
>>> the part of trauma surgery experts who are tired of
>> having federal program
>>> proponents foisting their ideologies and administrivia
>> into local matters. To
>>> me, the entry point is those who stick their hands
>> into the chests, bellies
>>> and
>>> extremities of those with whom they are expected and
>> entrusted to protect,
>>> rather than professional planners in DC, who for the
>> most part have no "real
>>> world" experience in the mitigation of surgical
>> and medical emergencies -
>>> especially on a massive scale.
>>>
>>> What they are saying is that the system is vertically
>> integrated (top-down)
>>> along federal funding guidelines, and not constructed
>> around rational local
>>> needs and requirements based on resources and demand.
>> In fact, the medical
>>> community has been bypassed, and is considered by many
>> an afterthought.
>>> Property be
>>> damned, for my money, I want someone who can save my
>> life - even within the
>>> construct of the federal template. But, no one's
>> listening. Thus, these
>>> postings.
>>>
>>> Bob Kellow
>>>
>>>
>>> **************
>>> Psssst...Have you heard the news? There's a new
>>> fashion blog, plus the latest fall trends and hair
>> styles at StyleList.com.
>>>      
>>>
>> (http://www.stylelist.com/trends?ncid=aolsty00050000000014)
>>> --
>>> 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/
> 
> 
> ------------------------------
> 
> Message: 10
> Date: Wed, 17 Sep 2008 16:03:54 -0400
> From: Larry Torrey 
> Subject: Re: SV: Needle Decompression
> To: "Trauma & Critical Care mailing list" 
> Message-ID: 
> Content-Type: text/plain; charset=windows-1252; format=flowed
> 
> Understand that the first of these studies (that I recall seeing) were 
> done on and for US Army Rangers.  If one is familiar with the Ranger 
> Regiment you will know that they are typically a well-muscled group of 
> gentlemen with a larger than average pectoralis major.  There was a 
> question as to whether a standard 1.25 inch IV catheter would penetrate 
> their oversized pecs, and the answer was often 'no'.
> 
> I will leave it to others to comment on how this may extrapolate to the 
> general public and what other studies may have shown.  It does seem 
> intuitive to think it would be difficult to go wrong with a longer cath.
> 
> Just trying to add some perspective.
> 
> LT
> 
> 
> Frank ?stergaard Hansen wrote:
>> Hay list
>> 
>> The TCCC say the needle must bee 3.25 inch and 14-gauge,  2 1/2 inch as dr
>> Mcswain says, it is not a new thing, know 3-4 studies don, whit US and CT,
>> that all say the same thing, normal IV needle is to short.
>> 
>> EMJ had a good paper on tension PTX, a while back, take a look at that one.
>> It was call "Tension pneumothorax?time for a re-think?" by S Leigh-Smith and
>> T Harris. Send me at mail if you like I have it.
>> 
>> Frank Hansen
>> 
>> -----Oprindelig meddelelse-----
>> Fra: McSwain, Norman E Jr. [mailto:nmcswai at tulane.edu] 
>> Sendt: 16. september 2008 15:41
>> Til: Trauma & Critical Care mailing list
>> Emne: RE: Needle Decompression
>> 
>> If you are really in the chest then it should be left in place. However
>> there is some good data from the Tactical Combat Casualty Care committee
>> that many needles are NOT long enough to penetrate into the chest
>> cavity. This is from some recent cadaver studies looking at the actual
>> anatomy and length of the needles used. The new standard for the
>> military developed by TCCC is that a 2 1/2 inch needle should be used to
>> successfully accomplish decompression. The usual needle for IV access
>> needle is 1 1/2 inches or shorter. 
>> 
>> 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 Sahaj Khalsa
>> Sent: Monday, September 15, 2008 11:48 PM
>> To: Trauma &, Critical Care mailing list
>> Subject: Needle Decompression
>> 
>> Hello all,
>> 
>> Many thanks to all of those who have been keeping all of us updated
>> about
>> their situations during this horrible hurricane season.  I have lots of
>> family in Houston so I felt like I had a more real and direct line to
>> what
>> was going on than the news, which was great.  Our thoughts and prayers
>> are
>> with all of you who are still recovering from all of the devastation.
>> 
>> So I am interested in the opinions of anybody on this list who cares to
>> share them and has a few spare minutes...
>> 
>> I am a Paramedic and a paramedic instructor and we are trained that when
>> we
>> decompress a chest (usually with a 14 ga catheter) and get blood flow
>> back,
>> we should pull the catheter.  Why?
>> 
>> I have discussed this with a number of the ER docs that I work with and
>> there is no real clear consensus.  Some of them say that I should leave
>> the
>> catheter in the chest as relieving the pressure is a good thing, whether
>> that pressure is caused by blood or air.  However, most Paramedic
>> textbooks
>> advise us to pull it.
>> 
>> Assuming that I have put the dart in correctly (and have not hit the
>> vessels
>> in the chest wall), understanding that I do not have the capability of
>> putting in a chest tube and that I am often times more than 60 minutes
>> by
>> ground from the nearest hospital with no alternative transport (helo)
>> available, what is your opinion?
>> 
>> Any replies would be appreciated.
>> 
>> Sahaj Khalsa
>> --
>> trauma-list : TRAUMA.ORG
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> 
> 
> ------------------------------
> 
> Message: 11
> Date: Thu, 18 Sep 2008 08:37:00 +1000
> From: John Holmes 
> Subject: RE: Needle Decompression
> To: "Trauma & Critical Care mailing list" 
> Message-ID: 
> Content-Type: text/plain; charset="iso-8859-1"
> 
> 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 > To: Trauma & Critical Care mailing list > 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 val
>  ue.>> 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" >>>>>> Date: Wed, 17 Sep 2008 11:50:12>>> To: 'Trauma & Critical Care mailing list'>>> 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 practi
>  tioner 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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> End of trauma-list Digest, Vol 63, Issue 30
> *******************************************

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