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The typical way to handle a pneumothorax (without an existing hole in the chest) in pre-hospital care is with a chest decompression needle, which is often a par

The typical way to handle a pneumothorax (without an existing hole in the chest) in pre-hospital care is with a chest decompression needle, which is often a part of a paramedic’s kit: https://www.narescue.com/ars-for-needle-decompression-3-25-in.html https://www.narescue.com/ars-for-needle-decompression-3-25-i... https://en.wikipedia.org/wiki/Thoracentesis https://en.wikipedia.org/wiki/Thoracentesis Would have been much easier than using a coat hanger and silverware if they had it on board, already pre-sterilized…

deleted 5y ago
[deleted]
robbiep 5y ago
Thats the typical way to handle a tension pneumo, which is slightly different but highly emergent. It's unlikely the case described was a tension pneumo because of the time period, but it very well could have developed that way, and regardless the treatment should be as useful - however one of the benefits of a needle decompression is that, because the lung has compressed so significantly, you don't have to be too concerned about where you drop it (ie you will always hit an airspace). whereas in the intermediate stages (which is what it sounds like they were treating), entering laterally ~4/5th intercostal space is better because you're less likely to hit lung which still occupies a significant percentage of the chest cavity - ie more likely to hit the air pocket AND provide definitive treatment (which clearly some macgyver surgery is not). So more than likely they were aiming to intervene before it needed to be a needle decompression. But also, they were probably thinking this is going to be a ripper of a story and we've got the skills to pull it off
- rkachowski 5y ago
  How much of a factor is the (relatively) super low air pressure in an airplane at cruising altitude? Does this cause more or less severity wrt the amount of air trapped in the chest?
  - KineticLensman 5y ago
    >> Wallace did not deem a landing at the nearest airport in Delhi to be viable either, because the increase in air pressure during descent could also kill his patient, and thus the only option was to perform an immediate surgery
    - rkachowski 5y ago
      That does not talk about the complications of the air pressure environment on the surgery itself.
  - robbiep 5y ago
    So i'm not an anaesthetist and therefore I claim no high ground with regard to this rusty attempt at respiratory and gas physiology - When I read it initially I thought - that makes sense, but I just did the equations, and basically the thing you're worried about is that the pocket of air that is outside the lung is going to change volume significantly and lead to the worst case outcome, a tension pneumo. But the volume of air outside the lung is going to be at cabin pressure, since that's where it developed. Cabin pressure is ~75kPa. Ground pressure is ~100kPa. The lung is going to exert more pressure than the gas so if you plug all that into boyle's law then you get a 75% reduction (or actually, you don't need to plug it into a calculator, because if you can't work out the percentage of 75/100 you're in trouble, so zero points to me). which would improve/stabilise. However maybe they were concerned the change in pressure could lead to a disequilibrium between lung pressure and potential space (of which there is always some due to breathing, and that sucking pressure into what should be a vacuum is what caused the pneumothorax - air leaking through a disruption in lung tissue) - and because the pressure differential is in favour of a flow into the low pressure zone, and that differential has increased, they're worrying about it shifting materially in a matter of minutes which could get bad quickly (particularly when you consider the potential for any leakage to become progressive, rather than, say, self-limiting) I don't know enough of this sort of edge case medicine to make any sort of definitive statements but if that was the physiology, maybe they decided it was out of the question to risk it --- I just realised I didn't really answer your question - which relates to, i guess, basically being at cruising altitude as it develops. Because it's steady state (ie inspired air/atmospheric air is going to end up similar pressure to trapped air) basically not significant in terms of progression until you get to blood oxygenation thresholds - because there's a lower partial pressure of O2 in cabin air compared to on the ground, the decreased lung volume is going to cause these issues to become apparent more rapidly. So it shouldn’t affect progression/growth of the pneumothorax, but it will exacerbate the physiological deterioration
- JshWright 5y ago
  The anterior axillary site is increasingly common for needle decompression as well. For the reason you mentioned, as well as the fact that it is a shorter distance (a common failure node for needle decompressions is the needle failing to reach the pleura).
- Traubenfuchs 5y ago
  „emergent“ means the prevalence is increasing? Why?
  - gumby 5y ago
    From your name and punctuation I assume you’re German. Thats actually not the use here but that meaning is common. “Emerge” is simply Frenchified Latin for ausgehen. In this case however it appears to be medical (perhaps ER) slang for “rapidly becoming an emergency”
    - robbiep 5y ago
      I’ve never thought of it as slang but rather a descriptive term for patient condition but you’re bang on
    - ramses0 5y ago
      Agreed: Chronic => continual/frequent (chronos?). Emergent => sudden (emerge?). "Emergency Care" => "Sudden Care". Urgent => important (urge?). It finally made a lot of sense realizing that an "emergent condition" is something that "comes out of nowhere" and is potentially rapidly changing. Versus "urgent care" as "something that should be taken care of promptly".
    - Traubenfuchs 5y ago
      Yes I am a German native speaker. I assumed emergent means „rapidly increasing numbers of“ and not „ Arising suddenly and unexpectedly, calling for quick judgment and prompt action.“.

deleted 5y ago

[deleted]

robbiep 5y ago

Thats the typical way to handle a tension pneumo, which is slightly different but highly emergent. It's unlikely the case described was a tension pneumo because of the time period, but it very well could have developed that way, and regardless the treatment should be as useful - however one of the benefits of a needle decompression is that, because the lung has compressed so significantly, you don't have to be too concerned about where you drop it (ie you will always hit an airspace). whereas in the intermediate stages (which is what it sounds like they were treating), entering laterally ~4/5th intercostal space is better because you're less likely to hit lung which still occupies a significant percentage of the chest cavity - ie more likely to hit the air pocket AND provide definitive treatment (which clearly some macgyver surgery is not). So more than likely they were aiming to intervene before it needed to be a needle decompression. But also, they were probably thinking this is going to be a ripper of a story and we've got the skills to pull it off

rkachowski 5y ago
How much of a factor is the (relatively) super low air pressure in an airplane at cruising altitude? Does this cause more or less severity wrt the amount of air trapped in the chest?
- KineticLensman 5y ago
  >> Wallace did not deem a landing at the nearest airport in Delhi to be viable either, because the increase in air pressure during descent could also kill his patient, and thus the only option was to perform an immediate surgery
  - rkachowski 5y ago
    That does not talk about the complications of the air pressure environment on the surgery itself.
- robbiep 5y ago
  So i'm not an anaesthetist and therefore I claim no high ground with regard to this rusty attempt at respiratory and gas physiology - When I read it initially I thought - that makes sense, but I just did the equations, and basically the thing you're worried about is that the pocket of air that is outside the lung is going to change volume significantly and lead to the worst case outcome, a tension pneumo. But the volume of air outside the lung is going to be at cabin pressure, since that's where it developed. Cabin pressure is ~75kPa. Ground pressure is ~100kPa. The lung is going to exert more pressure than the gas so if you plug all that into boyle's law then you get a 75% reduction (or actually, you don't need to plug it into a calculator, because if you can't work out the percentage of 75/100 you're in trouble, so zero points to me). which would improve/stabilise. However maybe they were concerned the change in pressure could lead to a disequilibrium between lung pressure and potential space (of which there is always some due to breathing, and that sucking pressure into what should be a vacuum is what caused the pneumothorax - air leaking through a disruption in lung tissue) - and because the pressure differential is in favour of a flow into the low pressure zone, and that differential has increased, they're worrying about it shifting materially in a matter of minutes which could get bad quickly (particularly when you consider the potential for any leakage to become progressive, rather than, say, self-limiting) I don't know enough of this sort of edge case medicine to make any sort of definitive statements but if that was the physiology, maybe they decided it was out of the question to risk it --- I just realised I didn't really answer your question - which relates to, i guess, basically being at cruising altitude as it develops. Because it's steady state (ie inspired air/atmospheric air is going to end up similar pressure to trapped air) basically not significant in terms of progression until you get to blood oxygenation thresholds - because there's a lower partial pressure of O2 in cabin air compared to on the ground, the decreased lung volume is going to cause these issues to become apparent more rapidly. So it shouldn’t affect progression/growth of the pneumothorax, but it will exacerbate the physiological deterioration
JshWright 5y ago
The anterior axillary site is increasingly common for needle decompression as well. For the reason you mentioned, as well as the fact that it is a shorter distance (a common failure node for needle decompressions is the needle failing to reach the pleura).
Traubenfuchs 5y ago
„emergent“ means the prevalence is increasing? Why?
- gumby 5y ago
  From your name and punctuation I assume you’re German. Thats actually not the use here but that meaning is common. “Emerge” is simply Frenchified Latin for ausgehen. In this case however it appears to be medical (perhaps ER) slang for “rapidly becoming an emergency”
  - robbiep 5y ago
    I’ve never thought of it as slang but rather a descriptive term for patient condition but you’re bang on
  - ramses0 5y ago
    Agreed: Chronic => continual/frequent (chronos?). Emergent => sudden (emerge?). "Emergency Care" => "Sudden Care". Urgent => important (urge?). It finally made a lot of sense realizing that an "emergent condition" is something that "comes out of nowhere" and is potentially rapidly changing. Versus "urgent care" as "something that should be taken care of promptly".
  - Traubenfuchs 5y ago
    Yes I am a German native speaker. I assumed emergent means „rapidly increasing numbers of“ and not „ Arising suddenly and unexpectedly, calling for quick judgment and prompt action.“.