Travel Reference
In-Depth Information
in a shift of the heart to the opposite side, the neck veins become distended and the person
develops signs of shock ( Chapter 3: Life-Threatening Problems ) .
Althoughsupplementaloxygenpartiallyalleviatessymptomsofpneumothorax,theonly
definitive treatment is removing the air trapped in the pleural cavity and allowing the lung
to expand. To accomplish this, a tube must be inserted into the pleural space, preferably by
an experienced medical professional. If the device is left in the pleura, a one-way valve or
suction apparatus must be applied to maintain the negative pleural pressure and expand the
lung. This procedure, tube thoracostomy, should not be attempted in the wilderness except
for rare circumstances in which an individual is dying as the result of a tension pneumo-
thorax.Onlymajorexpeditions orwell-equipped rescuegroupswouldbeexpected tocarry
the appropriate equipment and include medical professionals that could perform this pro-
cedure.
Tube Thoracostomy
Inserting a tube into the chest of an injured person in distress from a tension pneumo-
thorax can be life saving but is also a potentially hazardous procedure. The complications
include puncture of the heart, lung, or large blood vessel and penetration of the diaphragm
with injury to the underlying spleen or liver, all of which could be disastrous in the wilder-
ness.
Tube thoracostomy should only be attempted when the following conditions exist:
The individual is dying as a result of impaired respiratory function due to extensive air
in the chest, a condition virtually always the result of severe trauma.
The basic equipment, an appropriate tube for insertion and flutter valve (Heimlich
valve), is available.
Theindividualperformingtheprocedurehasbeenformallyinstructedor,underextreme
circumstances, is being monitored by a physician through telecommunication.
Optimally, a skin antiseptic and injectable local anesthesia should be available.
The following are the steps for emergency tube thoracostomy in the wilderness:
1. The injured person should be positioned on the ground, or on a cot, with the head sup-
ported on a pillow and the arm on the injured side elevated with the hand behind the
head.
2. If time permits, attendants should scrub their hands and forearms and the injured per-
son's injured chest from the clavicle to the lower margin of the ribs with soap. An anti-
septic, such as Betadine® or alcohol, should be applied to the cleansed chest wall. The
attendant should then put on sterile gloves if available.
3. A tube entrance site should be identified in the rib space below the large chest wall
muscle (pectoralis), or the breast in women, at the midaxillary level on the chest wall
( Fig. 9-4 ). This site is optimal because it allows access to the chest cavity after travers-
ing the least amount of tissue and is sufficiently high to avoid injury to the diaphragm.
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