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Document request

Bjorn, Pret pbjorn at emhs.org
Fri Aug 14 14:34:51 BST 2015


The concept of a "three-sided dressing" is sensible in theory but trickier in application.  There's blood and stuff.

Note that the cause of death in an open PTX is basically swift and agonizing suffocation.  That being the case, cover the hole with whatever you have (a gloved hand will do), then think about two things: where the nearest thoracostomy provider is, and how to recognize and temporize a tension pneumo if it occurs.  (It may be as simple as periodically lifting your hand up...)

Treat an open pneumothorax by closing it.  Then a chest tube.
Treat a tension pneumothorax by opening it.  Then a chest tube.
Treat a simple (non-trivial) pneumothorax by monitoring it.  With a chest tube.


Preston R. "Pret" Bjorn, RN
Eastern Maine Medical Center Trauma Care
489 State St.
Bangor, ME 04401

pbjorn at emhs.org
207.973.7260

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Greg Chapman
Sent: Friday, August 14, 2015 9:00 AM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Document request

So the question at hand is in a open (sucking) chest wound what would work
best.   Some recent data from the military suggests that the application of
a non-vented chest seal (or three sided dressing that has malfunctioned) can actually do more harm than no care at all.  If you take a simple pneumothorax and turn it into a tension by placing an occlusive dressing have we provided good patient care?

Greg Chapman BS.,RRT, REMT-P
Director, Center for Prehospital Medicine Carolinas Medical Center Charlotte NC
704-526-7525

On Fri, Aug 14, 2015 at 8:41 AM, Charles Krin <cskrin2 at hughes.net> wrote:

> I don't know about McSwain's Dart, but I understand that the failure
> rate of needle decompression is rather high...through a combination of
> adverse anatomy and diagnostic problems.
>
> Chuck
>
> On 8/14/2015 07:20, Robert Smith wrote:
> > Is there  a difference in empyema rate or other complication rates
> > chest
> tube vs. needle decompression?
> >
> >
> > Robert F. Smith MD, MPH
> > Cook County Trauma (ret)
> >
> >> On Aug 14, 2015, at 7:03 AM, Charles Krin <cskrin2 at hughes.net> wrote:
> >>
> >> I agree with Larry, but also pointed out that it is NOT something
> >> US paramedics are routinely educated and trained to handle, nor
> >> something that generally falls under a paramedic scope of practice
> >> to the best of my knowledge.
> >>
> >> And as more military medics transition back to civilian life, it
> >> will be interesting to see how it affects the National Registry and
> >> other Paramedic certifying groups. It is nice that most of the
> >> military medics are now able to test for appropriate NR levels
> >> (something that was not directly available when I was enlisted back
> >> in the early 1980s), but medics and corpsmen have been able to do
> >> *many* more procedures than their civilian counterparts, at least on other military members.
> >>
> >> Chuck
> >>
> >>
>
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