Approach to the trauma patient

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Peter W. -

Have written previously about using the scalpel without either a Kelly or a finger to rapidly dissect into the pleural space as being the fastest way to decompress a chest if needed. "Tunneling" with a Kelly is a time waster. After that, insert and sweep a finger to confirm location (and open a space between ribs if a chest tube is needed). Doesn't bedside ultrasound in a healthy patient confirming lung sliding should eliminate the need for empiric thoracostomies in a crashing patient?

Adan A. -

Scott, you mentioned that hemothorax doesn't require suction (generally). Have you encounter cases when the tube gets clogged with blood clots and stops draining?

EMCrit -

Can you point me to the previous writings. Scalpel entry through the intercostals is generally frowned upon as the anatomy of the neurovasc bundle unfortunately doesn't follow the textbooks

if you would stake your life (and your pts) on the pleural ultrasound, then by all means stop there. I generally am not willing to do that.

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