Steve,
The post was from Alastair Wilson (using my email).
In the case that tensioned immediately I have a strong suspicion that the
operator used a rigid needle rather than a cannula - or forgot to remove the
cannula before aspirating and so may have lacerated the lung. (or do I just have
a nasty suspicious mind?).
In the case that tensioned at half an hour all seemed to be well (could contact
with the parietal pleura disturb the clot that is sealing the hole in the visceral
pleura????).
Alastair has now abandoned aspiration in favour of either formal drainage or
conservative treatment. I still use aspiration, but make sure that the patient
remains in the department for an hour or so after the procedure, and make sure
they have a 'responsible adult' with them at home.
Tim.
> Tim
> This sounds like a very serious issue. Ive not heard of this before and have
> been a strong advocate of aspiration for years. Is this using a needle,
> venflon, Cook catheter or what? Was it successful in the two cases prior to
> deterioration or was there no improvement - in other words was there a risk
> these would have been sent home? I notice Francis' case was with a needle.
> Steve Meek
> RUH Bath
> > ----------
> > From: Timothy J Coats (SURG) 7728[SMTP:[log in to unmask]]
> > Sent: 25 November 1999 16:39
> > To: [log in to unmask]
> > Subject: Re: aspiration of spontaneous pneumothorax
> >
> > Well, Ive now had two cases of spontaneous pneumothorax aspirated by the
> > physicians that have gone on to have tension in the AED. The first was
> > only
> > just performed, the second had been done half an hour beforehand and had
> > tensioned to the point of respiratory/cardiac arrest. Not too sure about
> > those
> > BTS guidelines!
> >
> > AWW
> > Alastair WIlson.
> > A&E Consultant, Royal London Hospital.
> >
Timothy J Coats MD FRCS FFAEM
Senior Lecturer in Accident and Emergency / Pre-Hospital Care
Royal London Hospital, UK.
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