tension pneumo + hypotension

[Veneficus]

Originally Posted by Doczilla

I agree WHOLEHEARTEDLY. People shouldn't quibble over one detail, it'll give them tunnel vision. it just dosent work like that. You have to look at the whole picture. You should be spending more time trending vital signs, getting lung sounds and percussing, and doing a thorough reassessment.

I'll post some pics of a case study I kept from over there, where we accidently found a pneumo secondary to getting his foot blasted off from a landmine. Sneaky stuff. Prime example of the need to put the whole picture together.

Why would a pneumo not be suspected secondary to a blast injury?

There is still a shockwave.

[mycrofft]

And those sneaky little shrapnel bahstids.

[Veneficus]

Originally Posted by mycrofft

And those sneaky little shrapnel bahstids.

I didn't know you were from Boston

Actually I have a rather goodbook on describing IEDs sending blast debris along fascia planes instead of disrupting them.

I don't see why a landmine wouldn't do the same. (physics and all)

[Doczilla]

Because A: the guy came in from a local hospital after sitiing there for two hours and had no signs at that point (one of the first things I checked) and B: it reared its ugly head through a routine reassessment an our into our treatment.

[Veneficus]

Originally Posted by Doczilla

Because A: the guy came in from a local hospital after sitiing there for two hours and had no signs at that point (one of the first things I checked) and B: it reared its ugly head through a routine reassessment an our into our treatment.

Sounds like the normal progression of it.

[Doczilla]

Yeah, I'm not saying it was atypical or amazing, but the case study is a good teaching point, especially with the pictures. I'll post it later

[mycrofft]

Excellent.
Yeah, missiles of all sorts will follow funny paths ion side and outside the victim, especially if they are the typical "low" velocity of frags* (not primary missiles from high explosives at short range, though).

Hypotension sounds like the LAST sign.




*Also cheap or small handguns; had one that went through the antihelix of the ear, entered the skin behind the external ear, skimmed along the left lateral-nuccal skull and essentially popped out the posterior-left nuccal area. Knocked him down but all soft tissue damage. Shortbarrel .38 fired from a vehicle at about fifteen or twenty feet, victim quickly turned his head when the shooter called him.

[AnthonyM83]

I was taught to look for signs of hemodynamic instability / signs of shock...primarily skin signs and pulse rate/quality. In other words signs that the pneumo has progressed into tension. This way the Needle-T can be accomplished during the ABC's and no wasting time getting a BP on-scene.

In Los Angeles, it's 80 mmHg systolic to decompress without online medical control contact...seems a bit extreme.

As far as tracheal deviation, I was taught to feel for it, as one would notice the tension/tug when one pushes on either side before one visually notices a trachea moving to the side...

[SmokeMedic]

I will admit that I was always taught that it(tracheal deviation) was a late sign.....but I am always open to new ideas. In the end though I think the the earliest sign of a tension would be like many have said and present with the hemodynamic instability. It won't take very long for the CO to drop once the heart starts to get pressure on it. Obviously diminished unilateral lung sounds and respiratory distress wouldn't hurt either to get a even better differential.

[JakeEMTP]

I don't know if you read Rogue Medic's stuff but sometimes he has good discussions.

There was a podcast and discussion about tension pneumos and needle decompression.

http://roguemedic.com/2011/02/inadeq...le+Feedfetcher

Also here.
http://510medic.com/2011/02/01/ems-r...ast-episode-4/

It is a good arguement for ultrasound also.