Quote:
Originally Posted by olhamada
Thanks SS. Great case. ... He was splinting his right side, leaning forward supporting himself with his left arm, breathing through his mouth. When I walked in he immediately said, "I can't breathe"....
...I breathing 22/min, HR was 130...
... I quickly listened to his chest and heard no breath sounds on the right....
...What would you have done?
|
No offense, but he should have had a needle or chest tube RIGHT AT THIS POINT.
XRay should have been an afterthought to confirm your proper chest tube placement.
Quote:
|
One thing I didn't say, is that this was an outlying hospital with no good surgical backup, and it would take at least an hour to get him to a trauma center even with LifeFlight. I didn't have an hour. I had a few minutes at most.
|
No, you DID have an hour. You had several hours. He has already demonstrated that his hemothorax is not that brisk (he accumulated those 850 ccs in his chest over the 4 hours he was sitting there), not in the seconds after you placed the tube) and you addressed his limmediate life-threatening injury already.
I would submit you have no options
other than transferring the patient to a trauma center. An ED thoracotomy has a dismal save rate (to hospital discharge) in
experienced hands.
Give him two large bore lines, get blood flowing, FFP and platelets as necessary, and get him to a trauma center stat.