Israeli Paramedics Association
3
The Israeli Paramedics Emergency Medical Journal
Chief Editor - Paramedic Neomi Zvi
TRAUMA --> Case Report
Tension Pneumothorax
By
Paramedic Ran Zehavi
Silence and peaceful all around. Dark figures, wrap in white Prayer Shawls , walking
slowly to the Synagogue...Saturday Morning in Jerusalem.
And we are on guard of our residence health...
The Alarm bell startle the silence.
All 4 of us jumped into the MICU.
Dr. Yoram Klien , Samuel ("Tchangul")
the EMT-B/driver , Adi Zehavi - junior
volunteer (yes, my son) and me , your
loyal servent , the Paramedic , Ran
Zehavi.
"You are going to Rammalla-Shchem Road ,
one of the village's BLS ambulance is going
to meet you there.." We heard the
dispatcher on the Radio.
Red lights , siren ....out of town.
We asked for more details "Resident of one
of the villages was stabbed few times by
one of his family. He is unconscious" said
the dispatcher.
About 20 minutes passed till we joined with
the BLS ambulance. We took the stretcher
to the side of the road - so few us can
access the victim more easily.
MICU of Jerusalem , Tension Pneumothorax
from right to left: Adi Zehavi , Dr. Klien ,
Paramedic Ran Zehavi
20 years old Beduine , with 2 stab wounds right above his left Clavicle., unconscious ,
Gasping , and there was no need for using a stethoscope , or percussion to recognize
the left Tension Pneumothorax with the Subcutaneous Emphysema.
The trauma pt was in deep shock and massive hemorrhage from his left shoulder.
The BLS ambulance EMT , put a direct pressure on the bleeding wound.
I was intubating the pt.(the intubation was difficult because the sun was
dazzling the view of the Larynx) , Samuel fixed the ETT, and ventilated ,
and I performed Needle Application.
Right after , an Inter-Costal Drain was inserted to his chest , by Dr. Klien.
During all that time , the EMT is pressing the bleeding.
We loaded the stratcher , and on the way to the Trauma Center , Dr, Klien & me
oppend 2 peripheral veins and 1 Central Vein (Femoralis). Adi was making pressure
on the bleeding.
Emergency driving , and , yet , we are 30 minutes away from Hospital.
Till we reached the hospital , out pt. got - 5000 cc of Ringer Lactate & 1 litter of
Hemmaccell (Colloid) , Ventilation with BV-ETT , with O2 - that result in increasing
Saturation from 65% to 99%.
Adi was still pressing the bleeding , and I replaced him from time to time.
I must give a big credite to the Trauma team of Haddassa Medical Center , for the
cooperation with us , by letting us bring the pt straight from the MICU into the OR
(that was prepaired and ready for our pt.) without the delay in the ER...
We continued the direct pressure till the Surgeon's Blade , released us.
A sad story with a Happy END.
Our pt , released from hospital after a while.
But the end could have been MUCH better if they were inviting us to "Hafla" (party) to
eat from the sheep that was grilled for the "Sulcha" (Arab ceremony of Reconcilliation)
party
************
Paramedic Neomi Zvi - May 2000