His pathophysiology of TPT (tension pneumothorax) is somewhat off, and his references are pretty weak, in the grand scheme. I'll dig into the references to his references later on as well. The fact that none of them are from trauma medicine, emergency medicine, or military medicine medical journals is kind of telling.
OTOH of this argument is that pretty much all of military medicine signed off on this twenty-plus years ago, from SF on down. You'd better have more than big balls backing your play to take on the Lords of Trauma.
And TPT from penetrating chest trauma develops much faster than he incorrectly states (BTDT), and also isn't nearly as clinically hard to diagnose as he makes out (seen that too).
Later this week we'll review his article in depth, and the relevant medical literature, and put something more comprehensive out.
Short answer: If you decide not to carry a chest needle, you're not a bad medic. Neither are you if you retain one in your kit.
While there's some merit in his points, I wouldn't countermand and chuck out the window a full third of TCCC clinical care solely on the basis of a blog post from a former paramedic and former Navy corpsman, at this point. That's weak sauce. Unless he turns out to be balls-on right.
The old saying goes "primum non nocere": first do no harm.
Only occasional pneumothoraces will develop rapidly, progressing to a patient in extremis where diagnosis, decision and intervention could be critical: if appropriate personnel and matériel are not at hand, the condition has to be counted as lethal.
Those with a proficiency at needle thoracostomy have first a proficiency at diagnosis and assessment of the need for the procedure, and then also a well-developed three-dimensional sense of where the needle must go, in what is essentially a blind manoeuvre, and where there are hazards and pintffalls, some of which are also potentially lethal.
https://www.thefirearmblog.com/blog/2021/11/29/ask-doc-please-stop-carrying-chest-darts/
ReplyDeleteCan we get a review by the main man himself?
A quick gloss of the article:
ReplyDeleteHe's not all wrong.
He's also not all right.
His pathophysiology of TPT (tension pneumothorax) is somewhat off, and his references are pretty weak, in the grand scheme. I'll dig into the references to his references later on as well. The fact that none of them are from trauma medicine, emergency medicine, or military medicine medical journals is kind of telling.
OTOH of this argument is that pretty much all of military medicine signed off on this twenty-plus years ago, from SF on down. You'd better have more than big balls backing your play to take on the Lords of Trauma.
And TPT from penetrating chest trauma develops much faster than he incorrectly states (BTDT), and also isn't nearly as clinically hard to diagnose as he makes out (seen that too).
Later this week we'll review his article in depth, and the relevant medical literature, and put something more comprehensive out.
Short answer:
If you decide not to carry a chest needle, you're not a bad medic.
Neither are you if you retain one in your kit.
While there's some merit in his points, I wouldn't countermand and chuck out the window a full third of TCCC clinical care solely on the basis of a blog post from a former paramedic and former Navy corpsman, at this point. That's weak sauce. Unless he turns out to be balls-on right.
It's an interesting question.
Watch this space.
The old saying goes "primum non nocere": first do no harm.
ReplyDeleteOnly occasional pneumothoraces will develop rapidly, progressing to a patient in extremis where diagnosis, decision and intervention could be critical: if appropriate personnel and matériel are not at hand, the condition has to be counted as lethal.
Those with a proficiency at needle thoracostomy have first a proficiency at diagnosis and assessment of the need for the procedure, and then also a well-developed three-dimensional sense of where the needle must go, in what is essentially a blind manoeuvre, and where there are hazards and pintffalls, some of which are also potentially lethal.
Did I misread the title? Is this the comment section for "Inside The Left Lung"?
ReplyDelete