Flail chest w/ nemothorax

[SauceyEMT]

You better be a really big person, because if you tried to flat board me with a pneumo, I'd hurt you bad.

I am

And I dont know ****...just asking

 

[Scout]

Oooh. How to treat a pnuemothorax off duty? Stay in your car, pull out cellphone, dial 911, keep driving.

Can we try and keep this tripe out of a thread asking about treatments. It is really starting to effect the threads if people just come in and bash someone for asking a question.


He ask how is it treated at BLS level not "should I treat at a BLS level". The friend happened across it while off duty which prompted a question as to how it would be treated on duty!!

 

[Sasha]

Can we try and keep this tripe out of a thread asking about treatments. It is really starting to effect the threads if people just come in and bash someone for asking a question.


He ask how is it treated at BLS level not "should I treat at a BLS level". The friend happened across it while off duty which prompted a question as to how it would be treated on duty!!

Uhhhm I wasn't bashing anyone, just stating my opinion that the best treatment for a pnuemo secondary to MVC by a bystander is to call 911.

 

[Wee-EMT]

How can this be treated on a BLS level?

At an EMR level:

ABC's
100% O2
Rapid trauma survey
Fully spinal immobilize
Close pneumothorax- Call for ALS
Open Pneumothorax- occlusive dressing taped down on 3 sides
Flail chest- Rigid splint taped down on exhale (cut a ped collar)

 

[Scout]

Uhhhm I wasn't bashing anyone, just stating my opinion that the best treatment for a pnuemo secondary to MVC by a bystander is to call 911.

And the opinion has no relevance to the question in the OP

 

[Sasha]

And the opinion has no relevance to the question in the OP

It does. His question was how to treat it at the BLS level. He did not specify on duty or off duty and even interjected an anecdote about a pnuemothorax that his friend encountered off duty.

And your comment also had no relevance to the OP, so get off my back. You didn't seem to take issue with the nemo reference.

 

[Ms.Medic]

Well, to what extent is what I'm asking.

I had a buddy of mine (who is BLS) who came across an MVA roll in which the driver of the rolled vehicle was tossed through the windshield. My buddy just so happened to have an O2/trauma kit in his car at the time. This is what brought up my curiousity as to what extent you can intervene at a BLS level.

I dont know about your area, but here, you cannot pull up on scene and administer ANY medication without working under the medical directors license, and even then you have to wait for the ambulance to bring equipment, and definately not as a volunteer. Not only that, but we have to have tags/stickers on our vehicle that states what we are carrying on our automobiles...

 

[daedalus]

At an EMR level:

ABC's
100% O2
Rapid trauma survey
Fully spinal immobilize
Close pneumothorax- Call for ALS
Open Pneumothorax- occlusive dressing taped down on 3 sides
Flail chest- Rigid splint taped down on exhale (cut a ped collar)

AKA nothing.

 

[Wee-EMT]

AKA nothing.

Precisely.....

 

[Ridryder911]

Tx. maybe nothing but the key is recognizing and doing the proper thing.

R/r 911

 

[daedalus]

Tx. maybe nothing but the key is recognizing and doing the proper thing.

R/r 911

Exactly. It is easy for an EMT to rattle off the BLS bandaid "treatment" algorithm but could they actually recognize it in the heat of the moment?

 

[fma08]

gooooooooo bossycow! Finding nemo in the thorax has a bad prognosis!

Think of the sepsis! Oh won't somebody please think of the sepsis!

 

[nomofica]

I can see why users believe this forum is going downhill.
-_-

To those who have posted useful/helpful information, thank you.

To those who haven't, well...


On a side note; I realize my questions are pretty "noobish". I'm a student and I'm still naive. But we all start off some place.

 

[AJ Hidell]

I realize my questions are pretty "noobish". I'm a student and I'm still naive. But we all start off some place.

There was nothing unreasonably n00bish about this question. It was a good question. And you got some good answers. But certainly you must have noticed that a lot of people here are quite serious about improving the professional image of EMS. Consequently, I believe it was your presentation, and not the question itself, that some took issue with. Come on, man... you gotta admit that butchering the word "pneumothorax", which I am sure was in your EMR book, is fair game for a little joking. You can either sulk off mad at the world, or else you can take the lighthearted hint that then intended and go on to improve yourself with greater attention to professional detail in the future.

 

[marineman]

question for those more knowledgeable than me, I know at the ALS level (at least in my area) we tube the patient. My understanding is we wrap the flail segment to splint the outside and ventilating through the tube basically splints from the inside. At the BLS level could a combitube be used to achieve a similar effect? It hasn't been mentioned yet so I figured I'd throw it out there. I'll admit I have less understanding of this particular area than I'd like so feel free to help me understand if the reasoning for the tube or anything else is wrong. I have thick skin.

 

[2630]

check your protocols! for me a basic cannot place an airway (ett) for anyone unless they are confirmed to be not breathing.
i had a run a few weeks ago where my pt was crushed between a small truck and the back wall of a garage. she had bilateral flail segments with diminished sounds on the right and absent on the left. trachea deviated to the right and rice crispies (sub-q emphysema) on the left. other then stabilizing the segments there was not much more to do with them (emt-i's are not allowed to decompress per protocol). once the flight nurse got onboard, she decompressed and then didn't think again about it.

 

[nomofica]

There was nothing unreasonably n00bish about this question. It was a good question. And you got some good answers. But certainly you must have noticed that a lot of people here are quite serious about improving the professional image of EMS. Consequently, I believe it was your presentation, and not the question itself, that some took issue with. Come on, man... you gotta admit that butchering the word "pneumothorax", which I am sure was in your EMR book, is fair game for a little joking. You can either sulk off mad at the world, or else you can take the lighthearted hint that then intended and go on to improve yourself with greater attention to professional detail in the future.

I acknowledged my mistake quite early in the thread. I'm not upset about that at all (hell, I'd make fun of myself too). And yes, some of the replies were witty (and I did laugh at my own expense). I've just noticed a slight sense of negativity that hovers in this forum. Shame, really...

 

[Moxiy]

I just finished my EMT course and our professor, a 10 year medic, says to treat this you are supposed to put pressure on the flail chest, put a trauma dressing over it, and do your best to tape it down to the non flail portion of the chest to avoid further internal puncture.

 

[nomofica]

I just finished my EMT course and our professor, a 10 year medic, says to treat this you are supposed to put pressure on the flail chest, put a trauma dressing over it, and do your best to tape it down to the non flail portion of the chest to avoid further internal puncture.

If I'm not mistaken, won't putting any sort of pressure on a flail chest will not only get the patient pissed off at you, but also increases chance of pushing the flail segment into an organ?

 

[Tincanfireman]

The "hug a pillow" method in conjunction with a couple of elastic roller bandages will stabilize without putting undue pressure on the rib cage (Vent, jump in here and hit me with a wet noodle if I'm off base). The thing you want to avoid is localized pressure on the underlying bone structure/organs. The pillow will diffuse the force and still support the thoracic structure.