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Aeromedical protocol for tube thoracostomy
POSTER 18 RURAL PREHOSPITAL AIRWAY MANAGEMENT Jack Rupp, Holly Herron, Barb Strauch, Robert Falcone, Grant LifeFlight, IllS. Grant Ave., Columbus OH 43215 Introduction Can we improve rural prehospital airway management? Methods Review of 1987 scene runs including: EMS, Trauma Score on aeromedical crew (LF) arrival at scene (TS1) and at base hospital (TS2), airway management and outcome. Results 87/191 patients were treated by Basic Life Support providers (BLS), Group 1; 104/191 patients were treated by Advanced Life Support providers (ALS), Group 2; the majority of EMS were rural. Group 1 was 30.7 years old. Airway management included: None in 28, Oxygen in 50, Bag Mask in 6 and EOA in 3. 51/87 patients (58.6%) with TS1=11.0, TS2=11.2 had definitive airway management by LF including: Oxygen in 22, Intubation in 23 and Cricothyrotomy in 6. Definitive airway management was delayed 35.9 minutes in this sub-group; they accounted for 10/11(90.9%) of Group 1 deaths. Group 2 was 29. 6 years of age. Airway management included: None in 20, Oxygen in 51, Bag Mask in 5, Intubation in 23, and Cricothyrotomy in 5. 36/104 patients(34.6%) with TS1=12.7, TS2=13.1 (both> Group 1, p
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POSTER 19 AEROMEDICAL PROTOCOL FOR TUBE THORACOSTOMY Donna York, Chip Kramer, Laura Dudek, David Dries, Wendy Marshall LOYOLA LIFESTAR: Loyola Univ. Medical Center; 2160 S. First Ave. Maywood, Illinois 60153 INTRODUCTION: Reduction in mortality for aeromedical patients is due to life-saving care provided by crews at outlying hospitals or at accident scenes. Tube thoracostomy, a central aspect of care for acute chest injuries, is not commonly employed with nurse/paramedic crews. This report describes our experience with use of tube thoracostomy. MATERIALS/METHODS: 188 flights over a 6 month period were reviewed. Monitors included pulse oximetry, noninvasive automatic blood pressure, EKG, and breath sounds. Needle decompression followed by chest tube was performed for; changing compliance, decreasing oxygen saturation, mechanism of injury, traumatic arrest and diminished or unequal breath sounds. Insertion technique included incision at the midaxillary line in the 5th intercostal space and blunt placement of large bore tubes without use of a trocar. Tubes were inserted by nurses and paramedics trained to A TLS standards. RESULTS: 73 flights were for primary trauma and 13 patients received chest tube placement (18%). The principle site of insertion was inside the helicopter (60%). Release of air or blood consistent with pneumothorax or hemothorax was present with each chest tube insertion. Emergency Department diagnoses included pulmonary contusion (19%), multiple rib fractures (14%), cardiac contusion (12%) and closed head injury (12%). The majority of chest tubes were removed in 2 days or less. Only I chest tube was left in for more than 10 days. Complications were consistent with previous reports in trauma patients. CONCLUSION: Our experience, with no false positives, warrants a more aggressive use of tube thoracostomy. This approach is consistent with ATLS standards. Tube thoracostomy can be performed safely by nurses and paramedics in the aeromedical setting.
The Journal of Air Medical Transport • October 1989
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POSTER 19 AEROMEDICAL PROTOCOL FOR TUBE THORACOSTOMY Donna York, Chip Kramer, Laura Dudek, David Dries, Wendy Marshall LOYOLA LIFESTAR: Loyola Univ. Medical Center; 2160 S. First Ave. Maywood, Illinois 60153 INTRODUCTION: Reduction in mortality for aeromedical patients is due to life-saving care provided by crews at outlying hospitals or at accident scenes. Tube thoracostomy, a central aspect of care for acute chest injuries, is not commonly employed with nurse/paramedic crews. This report describes our experience with use of tube thoracostomy. MATERIALS/METHODS: 188 flights over a 6 month period were reviewed. Monitors included pulse oximetry, noninvasive automatic blood pressure, EKG, and breath sounds. Needle decompression followed by chest tube was performed for; changing compliance, decreasing oxygen saturation, mechanism of injury, traumatic arrest and diminished or unequal breath sounds. Insertion technique included incision at the midaxillary line in the 5th intercostal space and blunt placement of large bore tubes without use of a trocar. Tubes were inserted by nurses and paramedics trained to A TLS standards. RESULTS: 73 flights were for primary trauma and 13 patients received chest tube placement (18%). The principle site of insertion was inside the helicopter (60%). Release of air or blood consistent with pneumothorax or hemothorax was present with each chest tube insertion. Emergency Department diagnoses included pulmonary contusion (19%), multiple rib fractures (14%), cardiac contusion (12%) and closed head injury (12%). The majority of chest tubes were removed in 2 days or less. Only I chest tube was left in for more than 10 days. Complications were consistent with previous reports in trauma patients. CONCLUSION: Our experience, with no false positives, warrants a more aggressive use of tube thoracostomy. This approach is consistent with ATLS standards. Tube thoracostomy can be performed safely by nurses and paramedics in the aeromedical setting.
The Journal of Air Medical Transport • October 1989