Pneumothroax Transport Destination

[AeroClinician]

Here is the situation, you have a pt. that was involved in a motorcycle accident and your pt. only complains of back pain. Still has helmet on. A/Ox4, GCS 15, PERRL, Neuro exam and Stroke Exam Normal, denied loss of counciouness. HR, B/P Normal, EKG Sinus Rhythm. While your backboarding the pt. he states that he is not sure if he is having some difficulty breathing. L/S present with clr left lung and a clr right but your unsure if the right sounds more diminished than the left. SpO2 reads 96%. You have a Lvl 1 trauma center 40mins away going emergency and a primary reciving hospital 15 mins away going emergency.

Now, you have a suspected to be possible pneumothorax, and if that is what it is it is in its early stages of onset. And as a result you are not going to decompress this pt. unless the pt. gets worse.

You need to decide to either fly this pt. to the trauma center or call the priamary facility and check if they are capable of handling a pneumothorax then transporting code 3. What is the more adventagious route?

 

[DrankTheKoolaid]

Ground transport to whichever facility is approved to receive trauma that is closest would be most appropriate, unless protocols dictate otherwise. Patient is stable and no reason for Code 3 transport. What you do need to consider is this patient may become more short of breath and if on a backboard then what. May want to consider. KED and leave him sitting upright on the gurney. Plenty of people live with pneumos that are simply reabsorbed as long as they do not cause any other problems.

 

[Hockey]

Trauma center.

 

[AeroClinician]

Ground transport to whichever facility is approved to receive trauma would be most appropriate. If it

The primary reciving hospital is a community hospital and can recieve trauma pt.s, but it is just not a FL state approved lvl 1 trauma center. Can handle long bone fractures, not facial fractures.

If you call the primary hosp. and they have chest tube capability it would make sense to go there instead?

 

[AeroClinician]

By the way, if you go to the lvl 1 trauma center you must fly due to greater than 30mins trasport time. Weather is good.

 

[DrankTheKoolaid]

You would have to fall back onto your protocols then. But a simple pneumo doesnt need a level 1, hell a tension doesnt either once a chest tube is in.

Im going to assume your protocol reads if X criteria is met then direct transport to X trauma facility unless there is uncontrolled bleeding, or a failed airway. In those cases divert to closest ED

 

[AeroClinician]

Patient is stable and no reason for Code 3 transport. QUOTE]

Reason for code 3 transport is because if it is a pneumo then it could potentualy get worse and turn into a tension pnemo.

Is that a plausible reason for code 3?

 

[Medic Tim]

Patient is stable and no reason for Code 3 transport.

Reason for code 3 transport is because if it is a pneumo then it could potentualy get worse and turn into a tension pnemo.

Is that a plausible reason for code 3?

If the pt is stable there is no need to go ls. Many ppl do but that doesn't mean it is needed or right.

 

[STXmedic]

Reason for code 3 transport is because if it is a pneumo then it could potentualy get worse and turn into a tension pnemo.

Is that a plausible reason for code 3?

Are you a paramedic? If so, do you have the capability to mitigate a tension pneumo?

 

[JakeEMTP]

With back pain and difficulty breathing a spinal injury can not be excluded. Innervation to the diaphragm could be impaired with paralysis on just one side which could give the presentation of diminished breath sounds.


If it was just a pneumothorax, just about any ER can hand that.

The local hospital could probably stabilize a SCI with intubation and prepare to transport by the most appropriate team although that might take several hours to arrange.

 

[DrankTheKoolaid]

No. He gets worse you needle his chest and the world is all good again and you continue on your merry way. Still no reason for C3 unless he remains unstable.

30 minutes....... And what if air isnt available or on another run? Are you just going to sit there with your patient and shoot the breeze? What if they are delayed enough to make the time difference a wash?

I noticed you said "must". Is this a hard protocol for you for some reason?

 

[AeroClinician]

Im going to assume your protocol reads if X criteria is met then direct transport to X trauma facility unless there is uncontrolled bleeding, or a failed airway. In those cases divert to closest ED

This pt. wouldnt meet those direct criteria, and the transport to lvl 1 would then only happen if the pt. still needed the care of the lvl 1 cntr. despite not meeting trauma critera and would be a paramedic judgement situation.

 

[AeroClinician]

No. He gets worse you needle his chest and the world is all good again and you continue on your merry way. Still no reason for C3 unless he remains unstable.

30 minutes....... And what if air isnt available or on another run? Are you just going to sit there with your patient and shoot the breeze? What if they are delayed enough to make the time difference a wash?

I noticed you said "must". Is this a hard protocol for you for some reason?

Sorry, I shouldnt of said "MUST", yes if it is a wash due to delays or if weather is bad and they cant fly then you just go ground.

 

[AeroClinician]

No. He gets worse you needle his chest and the world is all good again and you continue on your merry way. Still no reason for C3 unless he remains unstable.

One of the definiate critera for lvl 1 transport is "Airway assistance beyond Oxygen Administration". Would'nt you consider decompressing a lung as beyond O2 admin.?

 

[JPINFV]

One of the definiate critera for lvl 1 transport is "Airway assistance beyond Oxygen Administration". Would'nt you consider decompressing a lung as beyond O2 admin.?

No... because it's not an airway issue. Additionally, the ED better be able to do a thoracostomy regardless of whether it's a trauma center.

 

[Veneficus]

If I could offer a perspective.

Go to the trauma center.

You described a pt who "might" have a pneumo.

Not every pneumo requires a chest tube. I have worked in centers that will not put in a chest tube if the pneumo self limits with less than 16% lung involvement unilaterally.

Despite the fact most people don't "need" a level I trauma center, do you think that this patient has only an isolated injury involving his lung?

 

[usalsfyre]

Go to the trauma center. The patient needs an evaluation by a trauma team. What they DON'T need is air or emergent transport. Trying to justify any other option hiding behind protocol is honestly, weak sauce.

 

[d_miracle36]

If you could transport to a trauma center via ground I might go that route. If not I would go to local hospital unless patient had other injuries. Air medical services are utilized way too much. The patient appears stable fro
The report and if he did have a pneumo then the local er should easily able to put in a chest tube then transport if needed. I don't think patients should be sent via air based solely on moi unless there are other injuries.

 

[AeroClinician]

Go to the trauma center. The patient needs an evaluation by a trauma team. What they DON'T need is air or emergent transport. Trying to justify any other option hiding behind protocol is honestly, weak sauce.

So you would drive the pt non emergency past the local hospital to the trauma center. If this pt needs evaluation by a trauma team instead of a local hospital Eval then wouldn't that warrant code 3 transport? If he is stable enough to be taken non emergency, then does he really need to go to the trauma center? Can't a local hospital check for other injuries and internal bleeding just as well?

I'm thinking this would best be managed by contacting medical controll and getting the doctors input from the local hospital.

 

[Aidey]

Just because someone needs a specialist doesn't mean they need lights and sirens. Specialists have been proven to help, lights and sirens have not.

And am I the only one who sees a problem with flying a possible pnuemo in an unpressurized aircraft?