I think the idea is that in an intubated patient with a tension PNX you do
not need the chest tube to allow ventilation, the thoracostomy is
sufficient. Should air reacumulate you just put your hand in the hole and
release it again. The positive pressure ventilation keeps the lung
sufficiently inflated. In normal breathing (where negative intrapleural
pressure expands the lung) it would clearly be a disaster. Since there is
then no immediate need to place the drain it would just waste time and
become a pain when you move the patient.
Once the patient arrives in hospital (or at a short time after) they get a
definitive chest drain.
I have also used the thoracostomy technique in the ED on the occasions where
I have found myself as the only person who can manage the airway/chest.
i.e. RSI/Intubation followed by rapid bilateral thoracostomies in a small
number of moribund patients
Simon
Simon Carley
SpR in Emergency Medicine
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Evidence based emergency medicine
http://www.bestbets.org
----- Original Message -----
From: "Dunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY - SwarkHosp-TR"
<[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, May 02, 2002 8:51 AM
Subject: Re: Chest drains - at all??
> > How do people feel about using chest drains pre-hospital?
> >
> > In some places they just do a thoracostomy, make sure the
> > hole is a decent size
> > and don't put the drain in until they reach hospital. I don't
> > know if this results
> > in more complications such as the thoracostomy hole closing
> > off en route, haemorrhage
> > from the wound site, infection etc but it certainly saves
> > time and means you
> > have less equipment to worry about in a speeding, crowded ambulance.
>
> Am I missing something? If you don't hold the hole open, your pneumothorax
> reaccumulates; if you do you have a sucking chest wound. If you have the
> skills to put a chest drain in, it takes a few seconds once you've created
a
> thoracostomy (connecting to bag rather than underwater seal); if you don't
> then a fair number of the fatal complications and major morbidity are
caused
> by the thoracostomy itself rather than insertion of the tube. You've also
> got a presumed high risk patient bleeding freely over your ambulance,
canvas
> and attendants rather than at least some of the blood going into a bottle.
>
> Matt Dunn
> Warwick
>
>
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