Prehospital Chest Tube Thoracostomy

[Ace844]

Nope. It's not.

So which are you a proponent of...?

[kevkei]

So which are you a proponent of...?

Chest tube baby, It's the only definitive treatment as you need the negative pressure involved. Needle thoracostomy only buys you time, it's a bridge to getting a chest tube.

[ERDoc]

I'm curious, those of you who put in chest tubes, please describe your techniques.

[Ace844]

I'm curious, those of you who put in chest tubes, please describe your techniques.

"ER Doc,"

I'm curious as to what you think of this issue. Would you support it's use in your system, if not then why? What are your thoughts on this..

out here,

Ace844

[Ridryder 911]

My technique is similar of that in ER, basically follow the same guideline(s) as outlined in ATLS. (of course this is someotmes dangerous without CXR confirmation). Some prefer trochar approach, I myself do not, I prefer making the incision and locating the pluera lining, spreading the opening with hemostat or clamp and manually inserting the clamp/tube, I also prefer to suture my tube in place as well and of course, secure as with any chest tube, the flight service I worked in had modified helmich valves in lieu of plera-vac. Understand most of these cases were obvious pneumo's with high percentage of lung involvement.

Not all medics or RN's were blessed only those that attended and completed ATLS and Advanced Trauma Care with respective lab and cadaver and sucessful clinical performance observations. As with any high risk procedure strict QI was monitored as well.

My feeling though that this is not a procedure for every Paramedic to perform; it should not be limited to the hospital arena. Especially when considering long transport time or expected delay > 30 minute to regional trauma facility. Repeated decompression to prevent or reduce tension pneumo's sometimes is not adequate enough and is not in the best interest of the patient.

Be safe,

Ridryder 911

[ERDoc]

"ER Doc,"

I'm curious as to what you think of this issue. Would you support it's use in your system, if not then why? What are your thoughts on this..

out here,

Ace844

Let me answer the question about my system first, the answer would be...NO. I can see field chest tubes as useful in areas where there is a prolonged response time, but only by trained personel. I don't feel a knife belongs in every paramedics hands. You are talking about a surgical procedure done under less than perfect conditons. I agree with Rid, there needs to be QA/QI and very close monitoring. There are so many potential complications that makes it a dangerous procedure, even in the ER. I've seen seasoned surgeons put the tube in the abd cavity (nothing like seeing stool come out of a chest tube to tighten the sphincter). I do have to say though, that I have not had any experience with medics outside of my area. My feelings on this might be different if I were to see medics from other areas. There are medics in my area that I would have no problem with putting in chest tubes, but most I would not feel comfortable.

[Ridryder 911]

I agree with ER Doc, I too don't feel comfortable with "most Medics performing this skill. Again, just because you dropped a lung does not suggest a chest tube, especially in the field setting. Yes, by all means one has to be specially trained "when it is appropriate" as much as "how to perform" this procedure. I don't want to reflect that I am in favor of scalpel toting medics.

I too have seen the consequences of improper tube placement and even difficult ones to place, with seasoned ER & thoracic surgeons. Again, incidences with prolong transport to a surgical theater or aggressive ER and those with obvious traumatic tension pneumo ( with high predictability of poor outcome) this may need to be considered & introduced in education.

Be safe,

Ridryder 911

[zippyRN]

Interesting study. Now someone needs to compare prehospital medic chest tubes and it may make it a benefit to the prehospital world (really, how many flight physicians are there really).

how about all the EU countries that use the 'German' model of EMS , London HEMS , other UK Air ambs on a sessional basis (some fly with physicians when available others have Immediate care physicians who respond to scenes and are trained to fly if necessary ), not sure if the Dutch model uses flight physicians or whether the physicians responding as part of the mobile medical teams fly if needed

[Guest]

Our Critical Care flight medics, do thoracostomys under standing orders and have a great success rate.

Please provide the stats, perhaps to door discharge and complications sorry I dont believe you, and please include the number of Registered CCP-F in your province as well.

Thanks for the evidence based medicine factual data in advance.

Squint the Canadian watch DAWGs are us. ps watch out for Ontarios comments.

[Dustdevil]

Squint, exactly what province is "the wind" in?