: Thank you all so much for the input and the resources. I ended up having to completely re-write the scene in order to make it realistic but it saved me from making an error which would have been patently obvious to the target audience.
This is a follow-up on my original question.Scene/Setting
: mid 1990s, rural setting (they're just coming up out of an extremely isolated high desert/mountain terrain), en route via ambulance to a reservation clinic. This is a modern western, but that doesn't have much impact on the question at hand. The patient is a fifteen year old who has been shot twice with a compromised airway. The patient has already crashed. She was doing fine on oxygen and then her vitals just went down the tubes. The paramedic (yes, I'm already aware that they likely wouldn't have had one but the reason she's there is already accounted for in the story) is about to intubate and put in the chest tube (also taken care of via story line and research --- she has the okay from the person who handles the paramedics' protocols).Searches and web pages used
: deviated trachea, pneumothorax, intubation, chest tube, ALS procedures, airway maintenence, tension pneumothorax. I found articles at Wikipedia, MedlinePlus, WebMD, Cascade Hospital
, and University of Virginia Health Systems
. However, none of them are specific enough for the information I need.What I need
: When the assessment is done, what gets done first: the intubation or the chest tube? Is it even possible to intubate with a deviated trachea? Is it even necessary to intubate if the chest tube takes care of the tension pneumothorax? If not, what are they going to do to keep her breathing in the field? Also, one article says that bag-mask ventilation is used WITH intubation but the other indicates that intubation is a superior procedure and would suffice by itself. Which way is correct?
None of these procedures need to take long; they're not far from medical help, they're just too far out to safely manage her condition and wait until a physician can get to her.