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Trauma: just another statistic?

01 July 2011
Features
02 July 2011
Volume 3 · Issue 7

Abstract

This article explores the clinical assessment, diagnosis and current management of tension pneumothoraces in the prehospital arena by UK ambulance service paramedics. Using a case study from clinical practice, the signs and symptoms, aetiology and clinical manifestations of tension pneumothoraces are examined, with the specific aim of achieving an accurate diagnosis and effective pleural decompression. This article explores the effectiveness of needle thoracocentesis: the sole method of pleural decompression currently available to UK paramedics. It aims to compare the effectiveness of this procedure with other, and considered more reliable, methods of pleural decompression. Inherent risks and associated complications are examined and conclusions are drawn, including the proposal that critical care helicopter emergency medical services (HEMS) paramedics who have completed additional educational programmes, operating under strict clinical governance systems, and who are frequently exposed to seriously injured patients, be afforded the autonomy to practice incision thoracostomies in traumatic cardiac arrest patients in the absence of their medical colleagues.

A34-year-old motorcyclist of athletic build was involved in a road traffic collision. Witnesses stated the motorcyclist collided with a car at speed, coming to rest several feet from the initial point of impact. Before the arrival of the dual-paramedic helicopter emergency medical services (HEMS) aircrew, the motorcyclist's helmet had been removed by bystanders to facilitate basic airway control.

The air ambulance crew noted a significant quantity of blood originating from an epistaxis contained within his oropharynx, and obvious facial fractures were visible. The motorcyclist was unresponsive, apnoeic and pulseless with peripheral cyanosis, and there were visible contusions to his anterior chest wall with suspected underlying rib fractures. An electrocardiography (ECG) revealed pulseless electrical activity.

Resuscitation efforts were immediately initiated and a pelvic binder was applied to immobilize an open-book pelvic fracture, a common injury inflicted following a direct blow to the pubis bone, one of three principal bones composing either half of the pelvis (Moore and Dalley, 2005).

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Aeromedical transport
Chest trauma
Tension pneumothorax
Traumatic cardiac arrest