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Subject: conservative tx of traumatic chest trauma An interesting question Simon. When I was posted to a small(ish) rural hospital without an A&E Obs ward I seemed to have a run of these. They did get a chest drain, and I like to think it was for proper medical reasons rather than just me wanting to do something practical. My justification (and I think it is right), is that Sods law decrees that otherwise they will get a tension, and be seen in the night by a PRHO who will miss whats happening and start throwing Ventolin at them because they are SOB. If you can guarantee decent monitoring, and the availability of someone experienced to sort it out quickly when it goes bad,then I think conservative management is the right thing. I just feel that in many cases this council of perfection is unobtainable, and so conservative management is a little too risky to feel comfortable with. David Roe A&E SpR, Mersey %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%