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Home > List Archives

trauma-list Digest, Vol 106, Issue 9

William Bromberg brombwi1 at memorialhealth.com
Mon Apr 16 14:49:19 BST 2012


Got a few of those pictures myself from EMTs placing darts in the field for "decreased breath sounds". And boy do they get pissed when you tell them that "decreased breath sounds" isn't an indication for a needle in a hemodynamically stable patient no matter how you frame it.
 
Bill Bromberg
 
William J. Bromberg, MD, FACS
Associate Professor of Surgery
Mercer University School of Medicine
Savannah Surgical Group
912 350-7412


>>> Andrew Bowman <andrewj.bowman at gmail.com> 4/16/2012 9:35 AM >>>
Then there are cases where a needle thoracentesis was performed, for chest trauma and dyspnea but no hemodynamics compromise. CT not only showed the needle did not reach the pleural space but there was no pneumothorax either. 

Andrew Bowman
Sent from my iPad2

On Apr 16, 2012, at 9:26, "Gross, Ronald" <Ronald.Gross at baystatehealth.org> wrote:

> Dr. Mattox has been saying that for years.  And on another note (I have not been following the threat ('cause clinical/admin load has been a bit "rigorous") but regarding Errington's post as I see it a pericardial tap in any acute presentation is useless and all but abandoned since ultrasound has become almost universal (and even where it isn't!).  If I am not correct, it is even disregarded in the latest ATLS edition
> 
> Ron
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of William Bromberg
> Sent: Monday, April 16, 2012 9:22 AM
> To: trauma-list at trauma.org 
> Subject: Re: trauma-list Digest, Vol 106, Issue 9
> 
> I've seen a few CT and autopsy studies that indicate that the needles don't get into the pleural space ~60% of the time (at least in the US -- home of the Whopper!)
> 
> Bill Bromberg
> 
> William J. Bromberg, MD, FACS
> Associate Professor of Surgery
> Mercer University School of Medicine
> Savannah Surgical Group
> 912 350-7412
> 
> 
>>>> John Hall <jrhmdtraum at aol.com> 4/16/2012 8:21 AM >>>
> I am seeing more and more people inserting bilateral chest tubes.  Never was taught this and have not seen it written (why better than bilateral needles).   Anybody?
> 
> I go for open chest thoracotomy if cardiac rhythm
>     A.  Closed chest CPR is proven worthless
>     B.  You get benefits of all other maneuvers
>     C.  If you are going to save the guy, it is the only way.
> 
> Sent from my iPad
> John R. Hall, M.D., F.A.C.S., F.C.C.M.
> Professor of Surgery
> 
> Also,  is it possible for people to "cut" the entire message out when posting ?
> 
> On Apr 16, 2012, at 4:29 AM, trauma-list-request at trauma.org wrote:
> 
>>>> Subject: Re: crushing case
>>>> 
>>>> I have not followed this thread. But it appears from the presentation u
>>>> have PEA. Need to go thru the drill. Bilateral chest tubes. Pericardial
>>>> tap. Fluids.
>>>> Errington C. Thompson, MD
>>>> Trauma/Critical Care
>>>> Sent from my Verizon Wireless 4GLTE Phone
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