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trauma-list Digest, Vol 106, Issue 9

Doc Holiday drydok at hotmail.com
Wed Apr 18 07:42:46 BST 2012

From: brombwi1 at memorialhealth.com
> I've seen a few CT and autopsy studies that indicate that the needles don't get into the pleural space...
--> This is certainly an issue. Many such cases can be identified by the operator and corrected IF these is a proper understanding of what they are trying to do and how, which is often not taught. If one does it properly and checks, then there are fewer such incidents.
If one then identifies that failure is likely or has happened, then there are longer needles and/or alternative locations (i.e. NOT 2nd ICS-MCL)
But despite all that, not on every patient are needles possible and then one will have to resort to a more formal thoracostomy for such cases. Again, one major key is knowing how to identify whether/when one's needle has failed to achieve its objective.
As for bilateral thoracostomies, they have become more common pre-hospital. I believe they have their uses, but I find them used too often by many who do use them. I generally prefer some sort of tube in each hole, to promote patency - seen to many such self-seal rather quickly and before ED arrival.
As for closed chest CPR being useless - I would qualifty that this is only for certain types of trauma. I am quite certain that it does contribute to survival in SOME "blunt trauma" circumstances, although by no means many.
I cannot for some reason right now locate a copy of the original case at the start of this thread. When I do, I'll see whether I can comment on it as well, but it might well be one of those for whom closed CPR would NOT be an option.
Finally, quite happy to accept that it may well not be possible to PROVE a "number one" option and then you end up with more than one potentially best way. I'd say the key is to have senior experienced clinicians at patient's arrival and they can form a patient-specific plan on the spot. 		 	   		  

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