PHTLS & Flail Chest

[Guest guest]

Brady Prehospital Emergency Care 8th Ed. Pg. 952: " Paradoxical movement

can also be stabilized by placing bulky dressings, a pillow, or towels

over the unstable segment, or by securing the patient's arm to his

body. "

Brady International Trauma Life Support 6th Ed. Pg. 101: " Initially,

stabilize the flail segment with manual pressure. Then stabilize it

with bulk dressings taped to the chest wall. "

American Academy of Orthopaedic Surgeons Advanced Assessment & Treatment

of Trauma c2010. Pg. 142: " If a flail segment is suspected, splint the

injured site with wide tape stretched from a noninjured area of the

chest over the injured area to a noninjured area of the chest wall. "

Mosby Jems, NAEMT Prehospital Trauma Life Support 6th Ed. Pg. 278:

" Efforts to stabilize the flail segment with sandbags or other means are

contraindicated. "

uh.... thoughts?

~Mark.

[Guest guest]

On Wednesday, April 28, 2010 15:59, " marksastre@... " marksastre@...>

said:

> uh.... thoughts?

I think it's a wonder that any of our students ever pass the NR exam.

Rob

[Guest guest]

On Wednesday, April 28, 2010 15:59, " marksastre@... " marksastre@...>

said:

> uh.... thoughts?

I think it's a wonder that any of our students ever pass the NR exam.

Rob

[Guest guest]

On Wednesday, April 28, 2010 15:59, " marksastre@... " marksastre@...>

said:

> uh.... thoughts?

I think it's a wonder that any of our students ever pass the NR exam.

Rob

[Guest guest]

Gene,

            You are so right!    'nuf said! 

________________________________

To: texasems-l

Sent: Thu, April 29, 2010 10:29:31 PM

Subject: RE: PHTLS & Flail Chest

One of the problems in EMS education is that we use EMS specific texts and

reference rather than general medical references.  

For example, if one reads Tintinalli on flail chest management, one finds this:

  " Historically, belts and adhesive tape were applied to strap and stabilize the

chest.  These interventions actually inhibit expansion of the chest and thereby

aggravate the atelectasis of the underlying lung.  The preferred intervention is

analgesia adequate to allow the patient to fully expand the underlying lung,

with a goal of improving ventilation and pulmonary toilet. "  

Tintinalli, Amergency Medicine, 6th ed., page 1601.

The key to treatment of flail chest is maintaining good ventilation and lung

expansion.  This can be done with positive pressure ventilation, which anybody

with a BVM can provide, and analgesia.  Many EMS educators and medical directors

would recoil in horror at the mention of giving IV analgesics to a patient with

rib fractures, simply because they don't know the fundamentals.

EMS educators must get over the notion that one textbook or program like PHTLS

or ITLS, can provide the depth of information needed to train paramedics.

 Paramedics must get over the idea that if they have read the text, they know

all there is to know about the field.  Only when one begins to seek out journal

literature and standard medical texts does one begin to learn about medicine.

Gene Gandy, JD, LP

On Apr 29, 2010, at 11:53:33 AM, " Toni Crippen " toni_crippen@...>

wrote:

From:  " Toni Crippen " toni_crippen@...>

Subject:    RE: PHTLS & Flail Chest

Date:  April 29, 2010 11:53:33 AM MST

To: texasems-l

Check the dates for each of those. As I understand it, the PHTLS is a

recent change as of December, 2008 / January, 2009. 

Toni 

From: texasems-l  [mailto:texasems-l ] On

Behalf Of marksastre@...

Sent: Wednesday, April 28, 2010 4:00 PM

To: texasems-l

Subject: PHTLS & Flail Chest

Brady Prehospital Emergency Care 8th Ed. Pg. 952: " Paradoxical movement

can also be stabilized by placing bulky dressings, a pillow, or towels

over the unstable segment, or by securing the patient's arm to his

body. "

Brady International Trauma Life Support 6th Ed. Pg. 101: " Initially,

stabilize the flail segment with manual pressure. Then stabilize it

with bulk dressings taped to the chest wall. "

American Academy of Orthopaedic Surgeons Advanced Assessment & Treatment

of Trauma c2010. Pg. 142: " If a flail segment is suspected, splint the

injured site with wide tape stretched from a noninjured area of the

chest over the injured area to a noninjured area of the chest wall. "

Mosby Jems, NAEMT Prehospital Trauma Life Support 6th Ed. Pg. 278:

" Efforts to stabilize the flail segment with sandbags or other means are

contraindicated. "

uh.... thoughts?

~Mark.

[Guest guest]

Gene,

That was beautifully and eloquently stated. However, as a current medical

student, allow me to add to your comment. " Only when one begins to seek out

journal literature, standard medical text and [appropriate rotations/experience]

does one begin to learn about medicine. "

In the basic science portion of medical school, they have taught us an enormous

deal of information. However, I don't think I have the confidence to recognize

the different causative agents of pneumonia yet without the clinical science

portion. Granted, my paramedic experience has left me light-years ahead of my

colleagues, but there is always something new to learn.

Good post counselor.

Regards,

Alfonso R. Ochoa

> Only when one begins to seek out journal literature and standard > medical

texts does one begin to learn about medicine.

>

> Gene Gandy, JD, LP

>