Dr Andrew Weatherall with an introduction to a new type of thing (well, for this site anyway).
*Ahem* [clears throat].
Well, we finally thought we should try chatting. After much delay we finally sat down and tried recording a chat with a microphone. And then after a much longer delay I have finally spent some time learning what to do with all that noise. All that slightly-too-quick-talking noise.
This effort features me chatting with Dr Alan Garner about those times you need to decompress the pleural space. It seems to be an area where a lot of people have passionate ideas about how and when to intervene. This makes it ideal for a chat, although maybe harder to be definitive about what to do. While Alan makes the argument that many of the disadvantages of tube thoracostomy first solved by the open technique have other solutions apparent in modern practice. However, all the options have some advantages and disadvantages, benefits and complications. That’s part of why it’s such an interesting topic.
I do need to share some extra bits of information, because it turns out 30 minutes of chatting still leaves some things unsaid:
- This is very much a learning thing at this end. So if there’s a few rough bits in the audio/recording and the like feel free to send some constructive feedback. Promise to get better at it.
- This chat actually happened way back in December (!!!) so apologies for taking this long to get it together. What that does mean is there’s a couple of bits that need an update – most particularly that the good Dr Garner has moved on from the Medical Director position at CareFlight. The excellent Dr Toby Fogg does that now (while Alan is still working pretty much as hard as ever, just not everywhere all at once).
- At the end of the podcast, we have a chat about the need for research. Well I don’t know if that got him moving but Alan is now putting together a retrospective study involving lots of centres and services across Sydney. Hopefully this will provide some more evidence to add to the mix and inform how to do future research better.
Now some papers are mentioned by Dr Garner as he goes along. So,
- Deakin CD, Davies G, Wilson A. J Simple thoracostomy avoids chest drain insertion in prehospital trauma. J Trauma 1995;39:373-4.
- Massarutti D, Trillò Gm Berlot G, Tomasini A, Bacer B, D’Orlando L, Viviani M, Rinaldi A, Babuin A, Burato L, Carchietti E. Simple thoracostomy in prehospital trauma management is safe and effective: a 2-year experience by helicopter emergency medical crews. Eur J Emerg Med 2006;12:276-80.
- Aylwin CJ, Brohi K, Davies GD, Walsh MS. Pre-Hospital and In-Hospital Thoracostomy: Indications and Complications. Ann R Coll Surg Engl. 2008;90:54-7.
As a bonus, here’s a reference for one looking at tube thoracostomy placement (as in whether it ends up in the right place, which was the case for 78%) which sort of highlights the importance of choosing the right bit of kit and being trained well:
- Maybauer MO, Geisser W, Wolff H, Maybauer DM. Incidence and outcome of tube thoracostomy positioning in trauma patients .Prehosp Emerg Care 2012;16:237-41.
Oh, and as a tracheal tube is sometimes suggested as an alternative to an intercostal catheter, it’s worth looking up this recent letter to the editor from Emergency Medicine Australasia, where a patient was unstable during transport with a tracheal tube in place to maintain the thoracostomy and subsequent investigation in hospital showed it had migrated. Yep, all techniques have their problems.
- Gluck S, Ellis DY, Pearce AP. Use of tracheal tubes as intercostal catheters. 2015. doi: 10.1111/1742-6723.12449. [Epub ahead of print]
Minh Le Cong reminded me that the draft NICE guidelines relating to trauma are up for people to comment on and obviously mention chest injury amongst many other things. Well worth a look (possibly via the excellent summary by Natalie May at St Emlyn’s.
Hope you enjoy it.
Wait, there’s some more acknowledgements:
A big thanks to Dr Minh Le Cong for the encouragement and advice.
We tried out two bits of music for this podcast and they were sourced from the lovely Podington Bear at the Free Music Archive. The first is ‘Mute Groove’ off the ‘Equatorial’ album. The end track is ‘Dole it Out’ from the album ‘Grit’.
Along the way I also picked up many useful tips from Joel Werner and Samuel Webster (disclosure: the good Mr Webster is my brother-in-law but is quite a good artist and everything person and I suspect I would have come across his work anyway).
The image here was from the flickr Creative Commons area and shared by Peter Trimming. It isn’t altered.