Document Detail


Chest tube decompression of blunt chest injuries by physicians in the field: effectiveness and complications.
MedLine Citation:
PMID:  9464755     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Recent literature suggests that patients who undergo emergent tube thoracostomy in the field are at increased risks for complications. This study evaluates indications, complications, and effectiveness of field placement of chest tubes by an aeromedical service. METHODS: In a prospective study, 624 consecutive patients with chest injuries (Abbreviated Injury Scale score 1-6) were included. All patients were treated at the scene by a physician-staffed aeromedical service and transported by air to a Level I trauma center. Indications, clinical findings before and after chest tube insertion, and subsequent radiologic diagnosis by chest roentgenography were documented prospectively. RESULTS: Seventy-six chest tubes (50 unilateral, 13 bilateral) were inserted laterally in 63 patients (10%) by blunt dissection. Clinical findings included pneumothorax in 30 patients and hemothorax in 18 patients. In 15 patients receiving field chest tubes, neither pneumothorax nor hemothorax was confirmed. Six patients (<1%) arrived at the trauma center with unsuspected pneumothoraces and required chest tube insertion. No tension pneumothoraces escaped field detection and treatment. Four chest tubes placed in the field required repositioning in the hospital because of malfunction or malpositioning. Radiologic findings excluded intraparenchymal tube placements in all patients. No pleural infections were observed in these 63 patients during their hospital stay. No antibiotics were administered as a result of prehospital chest tube placement. CONCLUSION: Prehospital chest tube thoracostomy is safe, effective, and associated with low morbidity. Nontherapeutic chest tube placements occurred in 15 of 624 patients (2.4%); missed pneumothoraces occurred in 6 of 624 patients (<1%). Aggressive prehospital physician management of blunt chest trauma leads to an earlier treatment of potentially life-threatening injuries. Significant morbidity can be avoided by prompt pleural decompression using proper techniques.
Authors:
U Schmidt; M Stalp; T Gerich; M Blauth; K I Maull; H Tscherne
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of trauma     Volume:  44     ISSN:  0022-5282     ISO Abbreviation:  J Trauma     Publication Date:  1998 Jan 
Date Detail:
Created Date:  1998-03-06     Completed Date:  1998-03-06     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376373     Medline TA:  J Trauma     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  98-101     Citation Subset:  AIM; IM    
Affiliation:
Department of Trauma Surgery, Hannover Medical School, Germany.
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MeSH Terms
Descriptor/Qualifier:
Abbreviated Injury Scale
Adult
Chest Tubes* / adverse effects
Clinical Protocols
Emergency Medical Services / methods
Female
Humans
Male
Prospective Studies
Thoracic Injuries / radiography,  surgery,  therapy*
Thoracostomy* / adverse effects
Treatment Outcome
Wounds, Nonpenetrating / radiography,  surgery,  therapy*
Wounds, Penetrating / therapy
Comments/Corrections
Comment In:
J Trauma. 1998 Jun;44(6):1115   [PMID:  9637178 ]

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