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Charles Krin cskrin2 at hughes.net
Fri Aug 14 17:38:30 BST 2015


Dr. Wigle:

you are correct, that is probably the quickest way to handle the "open
to tension" problem, if you have enough hands and eyes in the back of
the ambulance to keep track of everything.  A developing tension pneumo
can be a bit tricky to recognize in the back of the ambo at high speed
on rough roads, such as most of roads in rural Louisiana and Texas. (it
is also a good reason to put at least *two* caregivers in the back of
the ambulance, especially if an automatic ventilator is not available.)

Flight medics certainly should have the capability of placing chest
tubes, as as little an increase of 100 meters/330 feet in altitude can
make interesting differences in the volume of air that is trapped.

Chuck

On 8/14/2015 10:45, Richard Wigle MD FACS FCCM wrote:
> it would seem to me that if you have converted an open pneumothorax to a tension pneumothorax with your dressing you simply take the dressing down and relieve the tension
> I have never understood all the worrying about a 3 sided dressing, seems like a lot of fiddling being done in a critical patient
>  Richard L Wigle MD FACS FCCM 
>
>
>      On Friday, August 14, 2015 8:28 AM, Greg Chapman <chapmgre1 at gmail.com> wrote:
>    
>
>  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)
>>>



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