> 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.
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