Neck wounds

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certguy

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I was just on another site and they reccommended transporting a pt with an open neck wound in L lateral recumbent trendelenburg position To keep a potential air emboli trapped in the right atrium . I've never heard of this . Has anybody else ?


Craig
 
Yep, common treatment. As most neck wounds that are through the superficial layer should be sealed with an occlusive dressing and prevention of potential P.E. is a risk.

Even when establishing an EJ, air embolisms have been documented to occur by unsealed or free open cath (until IV tubing or lock is applied). Technically one is supposed to cover the lumen with a gloved finger then immediately attach the tubing.

R/r 911
 
But Rid.... how can you cover the lumen with a finger if you are an old-school medic and not wearing gloves?



I never thought of air emboli being a problem... I'll keep it in mind.
 
I can agree with the left lateral, but not to sure about the trendelenburg to be used a s a rule. I would think that one has to distinguish between Venous and Arterial insult or both. It can be difficuilt to distinguish, but I would have to say that for a arterial insult: just left lateral. For a venous insult, not the trendelenburg, but rather the opposite, whereyby the patients head is raised slightly. Should you not be sure, just left lateral.

Does it not make sense to say that should air be trapped in the right atrium and by you placing the patient with his head lower than his feet, the possibility of air going to the right ventricle is greater, as the highest point is no longer the atrium, but on equal level with the ventricle or higher???

For jon: No gloves?? Huh?? As old school medics, we should set the right example for the new school guys!

These are purly my own thoughts...
 
I just got sent home from Iraq because I was hit by an IED (Improvised Explosive Device) also know as a road side bomb, and the medics that flew me to the field hospital had me in the L lateral recumbent trendelenburg position. I had a lac to my right carotid artery from some shrapnel.

P.S. I hate IEDs
 
sorry to hear that james. i have tons of friends over in iraq, it's crazy what can happen over there.
 
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