John,
Our protocol would have been to intubated this casualty and make
bilateral thorocostomies (using sux/ketamine as you suggested).
BUT, this is in the context of pre-hospital doctors who are giving pre-
hospital anaesthesia on a daily basis.
I really would not be critical of your treatment. You were
oxygenating his lungs throughout. If he had vomited and aspirated
you might have been in more trouble. As you knew that he did not
have a significant head injury control of end-tidal CO2 was not
important.
In a perfect world I guess that all pre-hospital docs would have
frequent practise in pre-hospital anaesthesia. I am not sure if this
model is possible in the UK. We just have to do the best in the
circumstances that we find ourselves in. I would cease to worry too
much about this case!
Tim.
Timothy J Coats MD FRCS FFAEM
Senior Lecturer in Accident and Emergency / Pre-Hospital Care
Royal London Hospital, UK.
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