Thoracostomy at the Scene of an Accident in the Mountains
Intubation and ventilation of a seriously injured patient in the field is now an accepted and frequently used procedure. In case of a patient with chest trauma, this procedure can lead to a life-threatening tension pneumothorax.
In this case, thoracostomy of the injured side of the chest is mandatory to provide ventilation without causing a pneumothorax. lt does not make any sense, however, to do without a vital measure only because the doctor on emergency call is not capable of performing a thoracostomy. Therefore we require that all mountain rescue doctors should be able to do this procedure.
The following are the only indications for a thoracostomy at the scene of an accident in the mountains:
- to ventilate a patient with serious chest trauma and decreased or absent breath sounds (hemo- or pneumothorax)
- tension pneumothorax
Often there is a long time between the accident and the arrival of the doctor, then we have to deal with advanced shock and respiratory failure. So in spite of difficult conditions (terrain, weather) there are more liberal indications for intubation and also for thoracostomy at the scene. A long transport also supports the decision to perform a thoracostomy.
Please look at the attached file for the complete recommendation!