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Old 03-30-2009, 10:34   #9
RichL025
Quiet Professional
 
Join Date: Oct 2007
Location: San Antonio, TX
Posts: 377
Jumping in with my perspective here. Former 18D, now a surgery resident.

If someone has a quarter-sized hole in their flippin' chest and you're staring at lung, you had better be sealing it, unless you want a physiology experiment on single lung ventilation.

If by converting an open pnemothorax into a closed you create a tension, well, as a 11B basic trainee 22 years ago I was taught to "burp" the wound ... an extensive literature search on my part has failed to reveal any evidence supporting this practice but if you have someone not trained to perform a needle or chest tube that's better than nothing of course. You are directly addressing the pathology involved.

Although I have to believe that enough pressure to develop tension physiology would tend to pop the clot out of the wound anyway. Maybe not.

In answer to the previous question, yes to a chest tube. The only question is where to place it - in the field or can your patient wait until he gets to a nice clean medical facility?

I've been in med school and residency for the entire duration of this last conflict, so I'm not sure my input on where to place the tube is valid. If you know you only have a short flight to a CSH or FST, and you'll have someone who knows what they're doing watching your patient, then you could probably wait on the chest tube. Unsure evacuation time, mass casualties, etc then I would put one in before evac... but again, let me caveat that my field medic experience is a bit distant.
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