Flail chest w/ nemothorax

nomofica

nomofica

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How can this be treated on a BLS level?
 
Pneumothorax***

Open or closed pneumo?

Open:
Do a 3 way occlusive dressing. High flow 02, be ready to give assisted vents. Package. Load n go. Call for ALS is available in your area.

Closed:
Pretty much all the same except the 3 way occlusive dressing.

Key points:
Load n Go ASAP. Get ALS ASAP. Be ready for your patient to go downhill very quickly.
 
Yes, pneumothorax. Been a long day; don't ask...

I would assume pt be spineboarded to immobilize any movements that may cause the floating rib sections to puncture any organs, yes?
 
AJ Hidell said:
It can't..
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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.
 
nomofica said:
Yes, pneumothorax. Been a long day; don't ask...

I would assume pt be spineboarded to immobilize any movements that may cause the floating rib sections to puncture any organs, yes?
Click to expand...

I would backboard this pt. because a trauma significant enough to cause flail chest is definitely significant enough to cause spinal trauma.
 
LucidResq said:
I would backboard this pt. because a trauma significant enough to cause flail chest is definitely significant enough to cause spinal trauma.
Click to expand...

I guess that's pretty obvious, hey.
/smacks self
 
A spine board is not indicated, and not likely to immobilize the segments of the rib cage, which will move each time the patient breathes. Positioning the patient lateral recumbent on the affected side is the textbook preference. However in reality, the patient should be allowed to assume the position most comfortable to him or her.

Oxygen is obviously indicated, but other than that, there is no treatment, just supportive care.
 
AJ Hidell said:
A spine board is not indicated, and not likely to immobilize the segments of the rib cage, which will move each time the patient breathes. Positioning the patient lateral recumbent on the affected side is the textbook preference. However in reality, the patient should be allowed to assume the position most comfortable to him or her.

Oxygen is obviously indicated, but other than that, there is no treatment, just supportive care.
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So high flow O2, treat sucking chest wound if open pneumo, treat for shock/keep warm+comfortable(as can be...) and hope that ALS doesn't run into any major problems en route. That about it?
 
That's it. And in most cases, I would transport rather than wait for ALS.
 
nomofica said:
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.
Click to expand...


Mmm... I am reluctant to join the "mindlessly backboard everyone" club, AJ, but I would feel absolutely compelled to backboard who has just come out of the wrong end of the vehicular washing machine cycle. If someone had an isolated flail chest... if they were kicked once by a horse in the chest for example... position of comfort absolutely.
 
Sorry, I was posting that reply at the same time he was telling the story about being thrown through the windshield, so I didn't have that info at the time. I was addressing only the pneumo, which can happen any number of ways that would not require immobilization.
 
Oh PS am I blind or has splinting the flail segment not been mentioned yet?
 
AJ Hidell said:
That's it. And in most cases, I would transport rather than wait for ALS.
Click to expand...

Again, if you're not in uniform + behind the wheel of a personal vehicle (which would probably be more damaging to get the pt inside rather than wait for ALS).

But of course if you were in your EMS rig definitely load up and transport.
 
I was taught 5 things to remember in my emt class. Airway, Breathing, Circulation, Control major bleeding, and treat for shock.

Along with those 5 things I will also pretty much do what AJ said and give the guy a pillow to hug and wrap it to his chest to support the section. (if closed)
 
gooooooooo bossycow! Finding nemo in the thorax has a bad prognosis!
 
nomofica said:
Again, if you're not in uniform + behind the wheel of a personal vehicle (which would probably be more damaging to get the pt inside rather than wait for ALS).

But of course if you were in your EMS rig definitely load up and transport.
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Oooh. How to treat a pnuemothorax off duty? Stay in your car, pull out cellphone, dial 911, keep driving.
 
SauceyEMT said:
Um yeah...board him, no?
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You better be a really big person, because if you tried to flat board me with a pneumo, I'd hurt you bad.
 
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