chest decompression

usalsfyre

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BLS before ALS, occlusive dressing tape on three sides. If you notice tracheal deviation burp it. If that doesn’t work than go ALS.

If I'm thinking tension pneumo, I'm probably not going to waste time burping a dressing
 

usalsfyre

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To the non-US providers (especially down-under), are all of your providers doing open thoracotomies or just the HEMS doctors?
 

usafmedic45

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To the non-US providers (especially down-under), are all of your providers doing open thoracotomies or just the HEMS doctors?

You mean thoracostomies? Right? I don't know of anyone that allows a non-physician to do a field thoracotomies (outside of some really sporty SF medical personnel)
 

usalsfyre

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You mean thoracostomies? Right? I don't know of anyone that allows a non-physician to do a field thoracotomies (outside of some really sporty SF medical personnel)

Yep, thoracostomy is what I meant, dang my ADHD.

An open thoracotomy in the field would be uhhh, impressive to say the least...
 

usafmedic45

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An open thoracotomy in the field would be uhhh, impressive to say the least...

The location is secondary. It's not the location that matters or the technical ability to do the thoracotomy itself, it's the judgment that it takes to make the decision whether to do the procedure and the skill and knowledge to deal with what you might find upon opening up the chest. As one of my trauma surgeon friends put it, "Thoracotomies are like discussing your girlfriend's prowess in bed in front of her father. Only do either if you really want to deal with the cluster:censored::censored::censored::censored: that might ensue."
 

MrBrown

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To the non-US providers (especially down-under), are all of your providers doing open thoracotomies or just the HEMS doctors?

Our Intensive Care Paramedics do needle thoracostomy (Turkel chest decompression) whereas the HEMS Doctors (in AU) can do an open thoracotomy.

Same with HEMS in London, they have published some research on it.
 

Veneficus

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Tracheal deviation is a late sign and one that is difficult to note in the field especially with a cervical collar in place. There are signs that appear much earlier and are more apparent then tracheal deviation.

I would not rely on trach deviation when deciding to lift the occulsive dressing.

I would like to dispell this rmor immediately as it is one of my pet peeves.

Gross tracheal deviation is a late sign.

Tracheal deviation is defined as movement of 3mm or more from the line between the symphisis of the mandible and the jugular notch. It is not a late sign, it is just one that has to be actively searched for by actually attempting to measure it.

I agree it is not a finding suitable for field work.
 
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wdballer2431

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I agree with the trachael deviation being a late sign. Better signs to look for would be tachypnea, absent lung sounds, and hypotention due to pressure in the plueral cavity:rolleyes: causing a decrease in CO. Once again, sorry to anyone I offended with abbreviations, it is a forum not a job resume. I appreciate everyones opinions and feedback on treatment
 

Aidey

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I agree with the trachael deviation being a late sign. Better signs to look for would be tachypnea, absent lung sounds, and hypotention due to pressure in the plueral cavity:rolleyes: causing a decrease in CO. Once again, sorry to anyone I offended with abbreviations, it is a forum not a job resume. I appreciate everyones opinions and feedback on treatment


Huh?

Problem number 2 with abbreviations. Not everyone uses the same ones.
 

STXmedic

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I agree with the trachael deviation being a late sign. Better signs to look for would be tachypnea, absent lung sounds, and hypotention due to pressure in the plueral cavity:rolleyes: causing a decrease in CO. Once again, sorry to anyone I offended with abbreviations, it is a forum not a job resume. I appreciate everyones opinions and feedback on treatment

I like how you use the abbreviation for ease and quickness of writing, yet you then proceed to type out an entire sentence justifying it... Kind of defeats the purpose, huh? ;) Unless cardiac output is just too complicated to spell......
 

abckidsmom

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Huh?

Problem number 2 with abbreviations. Not everyone uses the same ones.


Cardiac Output. It's pretty standard, especially when viewed in context of the conversation.

Those are the signs I look for as well. If I'm worried about a tension pneumo, the patient is typically supine on a backboard. No need to cause further discomfort to a dyspneic patient by digging in to palpate their trachea.

If I believe a person has a tension pneumo and is unconscious, I might palpate for a learning experience, or a "gee that's neat" kind of thing, but I don't believe it's a helpful enough sign to cause that added anxiety in a conscious patient.
 
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wdballer2431

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I like how you use the abbreviation for ease and quickness of writing, yet you then proceed to type out an entire sentence justifying it... Kind of defeats the purpose, huh? ;) Unless cardiac output is just too complicated to spell......

Like abckidsmom wrote, CO is a very standard abbreviation, especially in the context of how I used it. Maybe we shouldnt use Bp or Hr because those might be too complex for everyone to understand. Medicine has endless amounts of abbreivations, so stop harping on it when I write one.
 

STXmedic

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Like abckidsmom wrote, CO is a very standard abbreviation, especially in the context of how I used it. Maybe we shouldnt use Bp or Hr because those might be too complex for everyone to understand. Medicine has endless amounts of abbreivations, so stop harping on it when I write one.

I'm not saying it's not. I knew exactly what you were referring to as soon as I read it. CO is absolutely an accepted abbreviation for cardiac output, especially in the context it was used. I use abbreviations all the time, and am guilty of sometimes even over-using them in my reports :) I just found it funny, and slightly redundant, that you used an abbreviation (which is generally used to save space or write quickly) and then followed it up with an explanation/justification of it's use. Again, kind of defeats the purpose :p
 

Veneficus

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If I'm thinking tension pneumo, I'm probably not going to waste time burping a dressing

I must second this statement.

Treat it and move on.
 

Smash

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Defib pads make great occlusive dressings for bigger/messier holes, just be sure to explain why they are in a strange place. Never even heard of "burping" the dressing; I can't imagine that it is any use, and I would be getting out my pneumocaths anyway. So I'll third usalsfyre's statement.
 

JPINFV

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gsw cover, burb,then ALS

Repeating yourself does not change anything...

Also, make sure to remind the physician to remember his "BLS" when he goes to put in a chest tube before burping the dressing. Please report back when you do.
 

usalsfyre

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Also worth repeating for the newer providers you need to be hypervigilant for signs of tension pneumo and ready to needle the chest anytime you provide PPV to a chest injury.
 

M3dicDO

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Also, make sure to remind the physician to remember his "BLS" when he goes to put in a chest tube before burping the dressing. Please report back when you do.

LMFAO!:lol:
 
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