OPTION
1. Conservative Mx 2. Needle aspiration 3. Pigtail catheter 4. Tube Thoracotomy |
PRO
Non invasive, allows discharge home No indwelling chest catheter, 75% success rate Less invasive than traditional tube thoracostomy, allows pt to be mobile/dioscharged with Heimlich valve Not compromised if bleeding occurs Can use for pleurodesis Traditional "gold standard" |
CON
Slow resolution, not supported by guidelines May fail and create need for ICC ay obstruct if bleeding occurs. Does not allow secondary therapy Very invasive compared to other therapies |
AGENT
1. Ketamine 1.5mg/kg 2. Propofol 0.5-1mg/kg 3. Thiopentone 3mg/kg 4. Fentanyl and midazolam |
PRO
Maintains BP and respiratory function No effect on ICP, antiemetic, readily available No effect on ICP Neuroprotective Cardiac stable |
CON
Emergence phenomenon Note Increase in ICP is NOT an acceptable disadvantage, as this is dogma that is not currently valid Risk of allergy (eggs/soybeans) May induce hypotension May induce hypotension and promote secondary ischaemic injury 2 drugs: more complex induction |
PLATFORM
1. ROAD 2. ROTARY WING 3. FIXED WING |
PRO
No pressure issues Easily available Point to point transfer Fast over 450km Fastest in the air, cabin compressible to sea level |
CON
SLOW, shorter range (not really suitable for 450km) Cannot be compressed Vibrations may worsen decompression illness Needs to add road leg either side, which adds significantly to time Needs available landing strip |