vs-eh? Posted May 21, 2006 Posted May 21, 2006 Correct me if I'm wrong, but is it not a requirement that you have a mediastinal shift (hypotension, trach. dev. AKA a TENSION pneumothorax) in order to do a needle thorocostomy? Is the pt presenting with this? VS? Standing orders for needle thoracostomy for Ontario are... - Mechanism for query tension pneumo - i.e. chest trauma, aggressive PPV, etc... - Severe and worsening SOB - Absence of breath sounds on affected side - Hypotension < 90 systolic... Oh ya, and you're supposed to patch for this... :roll:
ERDoc Posted May 21, 2006 Posted May 21, 2006 Correct me if I'm wrong, but is it not a requirement that you have a mediastinal shift (hypotension, trach. dev. AKA a TENSION pneumothorax) in order to do a needle thorocostomy? Is the pt presenting with this? VS? If you needle the chest this guy is going to end up with a chest tube in the ER. If you don't needle him, he will end up with a chest tube (and from the sounds of it he may end up with a full thoracostomy in the OR). I would say that if you are concerned and there is REAL evidence of a tension pneumo, do the needle (but follow your local protocols).
ERDoc Posted May 21, 2006 Posted May 21, 2006 compartment syndrome vary good thought, only thing is to confirm it a blood test needs to be done. But if compartment syndrome is there then sodium bicarb might be used, and yes hook i do agree with your thoughts and hammers, Uhm, what blood test would you want to confirm compartment syndrome? How would bicarb help? Are you sure about your understanding of compartment syndrome?
TZETAH Posted May 22, 2006 Author Posted May 22, 2006 a smaller combi-tube. Goes in easier, and is best used for all adults unless you have a really big guy. Chest tube is what pt received at the hospital. Thanks guys.
TZETAH Posted May 22, 2006 Author Posted May 22, 2006 What is compartment syndrome? Doesn't that pertain mostly to the legs?
vs-eh? Posted May 22, 2006 Posted May 22, 2006 Uhm, what blood test would you want to confirm compartment syndrome? How would bicarb help? Are you sure about your understanding of compartment syndrome? Must be thinking crush syndrome I guess? But ya, prehospital you wouldn't be using a blood test to confirm it. Clinical presentation and ECG changes would be your primary determination I would think if you were thinking bicarb... a smaller combi-tube. Goes in easier, and is best used for all adults unless you have a really big guy. Oh...you said intubate though. A combitube isn't intubation. But even still I don't understand. Why would you use this AS device if oral intubation was available to you? A combitube is a rescue device in the event of a failed intubation. Why would you go straight to that? I assume you can orally intubate since you said for some reason you would elect to go nasal (I assume intubation, unless it is some other device like this "AS" thing). Could you clarify please?
vs-eh? Posted May 22, 2006 Posted May 22, 2006 What is compartment syndrome? Doesn't that pertain mostly to the legs? Basically an injury that causes an increase or decrease in volume within an enclosed space. Usually in a limb as I recall. This can lead to various issues such as muscle/nerve damage, reduced perfusion, loss of function, etc...Assess the 5 (or 6) P's. I don't remember what the exact pressures are for stages of damage.
TZETAH Posted May 22, 2006 Author Posted May 22, 2006 well, I guess I am just saying/thinking-- you can't do oral with a gag reflex & if the situation went bad and pt goes unresponsive and does not react to painful stimuli then why would I do an oral instead of combi....just thinking that with 8000 plus pounds that if this pt goes down he will not respond to anything.... Thank goodness this did not happen..
cumcoemt84 Posted May 22, 2006 Posted May 22, 2006 compartment syndrome is the build up of lactic acid. and when released acidosis happens we had a case the other day. a car was on top of a man for at least 13 hrs when he was found the next morning. and form my understand sodium bicarb help by leveling out the PH form a lactic acidosis, and it is more in the arms and legs
TZETAH Posted May 22, 2006 Author Posted May 22, 2006 Than how does compartment syndrome have anything to do with the chest/lungs? I am missing something?
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