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Document request

Charles Krin cskrin2 at hughes.net
Fri Aug 14 14:58:51 BST 2015


OK...would it be reasonable to consider a short, fat, non trocar chest
tube that could be inserted through the sucking chest wound and then the
wound with an occlusive dressing and then vent the chest tube with a
Heimlich valve for routine paramedic use in circumstances where
transport is prolonged or delayed?

short, to help reduce the chance of penetrating the mediastinum or other
critical structures, fat (10 mm-30 French ID minimum) to help insure
that the system doesn't get gummed up by a clot, no trocar (again, to
reduce the chance of unwanted penetration), and the H valve to help
insure that stuff comes out but air does NOT go back into the cavity.
"Through the wound" utilizes the current trauma and doesn't require the
technical knowledge and proficiency to 'make the cut' needed to insert a
chest tube.

Chuck

On 8/14/2015 08:34, Bjorn, Pret wrote:
> 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
>>
>>



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