chest decompression

[wdballer2431]

What r u guys thoughts on penetrating trauma to the area of the 2nd/3rd intercoastal space with signs and symptoms of a tension. Best area to decompress. Also 3 or 4 sided occulsive dressing to the posterior with penetrating trauma to that area only. No exit wound on anterior chest. Most likely pt will be moved on long board. Thoughts??

 

[Smash]

My thoughts? I think that the English language is in it's death throes. I appreciate that language evolves (or devolves apparently) but the idea with these message boards is to communicate questions, opinions, ideas, and just very occassionally, facts. If the message is lost because of poor grammar and spelling, or excessive use of obscure abbreviations and acronyms, then we may as well not bother.

However, with regard to your questions: blunt finger dissection or needle decompression laterally for the tension pneumothorax. Anterior chest is not necessarily the best location for needle decompression anyway.

I'm not sure what I should think about the rest of it. I'm wondering why one wouldn't dress a wound. I'm wondering why they need to be on a spineboard. Im wondering why it would matter anyway. I'm wondering why there are so many question marks. I'm wondering what I'm going to have for breakfast.

Welcome to EMTLife.

 

[Veneficus]

My thoughts? I think that the English language is in it's death throes. I appreciate that language evolves (or devolves apparently) but the idea with these message boards is to communicate questions, opinions, ideas, and just very occassionally, facts. If the message is lost because of poor grammar and spelling, or excessive use of obscure abbreviations and acronyms, then we may as well not bother.

However, with regard to your questions: blunt finger dissection or needle decompression laterally for the tension pneumothorax. Anterior chest is not necessarily the best location for needle decompression anyway.

I'm not sure what I should think about the rest of it. I'm wondering why one wouldn't dress a wound. I'm wondering why they need to be on a spineboard. Im wondering why it would matter anyway. I'm wondering why there are so many question marks. I'm wondering what I'm going to have for breakfast.

Welcome to EMTLife.

But I like the anterior chest placement.

 

[Shishkabob]

We were taught not only superior anterior chest placement, but also the axial area of the lower chest in school. However, I don't know of an agency around here that allows needle thoracostomy to be done anywhere BUT the upper anterior aspect... apparently due to a time that a medic(s) pierced the spleen and/or liver and a receiving physician complained.


Granted I've never confirmed that story, but I havent seen any protocols of any agency in the area that allow axial placement.

 

[Smash]

I like anterior too, but I have seen a number of VERY bad placements. It seems to be common that people go too close to the sternum, skewering the internal mammary artery on an alarming number of patients.

 

[wdballer2431]

To Smash, I'mtyping on a phone. Don't see what's wrong with a few abbreviations. My question was having a gsw to the anterior chest with signs and symptoms if a tension pneumo. Would it be best to decompress as close to that area as possible?

 

[wdballer2431]

With that gsw being right in the area where u would typically decompress

 

[Smash]

My reply still stands, blunt finger dissection or needle laterally. You could make a hole beside the gunshot wound I guess. Where the hole is doesn't really matter that much, both in terms of the hole that caused it and the hole that fixed it (hopefully)

 

[usafmedic45]

My thoughts? I think that the English language is in it's death throes. I appreciate that language evolves (or devolves apparently) but the idea with these message boards is to communicate questions, opinions, ideas, and just very occassionally, facts. If the message is lost because of poor grammar and spelling, or excessive use of obscure abbreviations and acronyms, then we may as well not bother.

Amen.

apparently due to a time that a medic(s) pierced the spleen and/or liver and a receiving physician complained.

As opposed to hitting the heart, lung, or aorta....

To Smash, I'mtyping on a phone.

So?

Don't see what's wrong with a few abbreviations.

You mean besides the fact that it makes you look like you've been pithed? It's not just the abbreviations. The poor syntax and grammar also gives you less than a polished appearance.

Would it be best to decompress as close to that area as possible?

You do know what happens with air or fluid in the pleural cavity, right?

To answer your question, needle decompression should be only used if the patient is in extremis. It's overused by excessively eager paramedics.

 

[Shishkabob]

As opposed to hitting the heart, lung, or aorta....

Preaching to the choir...

 

[fast65]

I love the fact that grammar lessons always come first on this forum

As for the OP, everyone else has pretty much already answered your question...why not make a hole next to the GSW?

 

[lightsandsirens5]

My thoughts? I think that the English language is in it's death throes. I appreciate that language evolves (or devolves apparently) but the idea with these message boards is to communicate questions, opinions, ideas, and just very occassionally, facts. If the message is lost because of poor grammar and spelling, or excessive use of obscure abbreviations and acronyms, then we may as well not bother.

I love you.

 

[Smash]

I love you.

:wub:

 

[18G]

As far as the comments on the abbreviations, etc... I think they are out of line. People need to understand that the generation of today was brought up with the Internet, texting, hand-held devices, etc. This is all very natural to them and is as common to them as a pencil and paper is to you. It is what it is and they aren't gonna change for you. I understood the OP's questions perfectly.

As the OP stated, he was typing on a hand-held device where abbreviations make it much easier to get your msg out. If you don't understand the abbreviations then I would recommend you come up to speed.

Now to the actual question.... when my class was practicing the chest decompression on a cadaver, our medical director showed us the typical anterior (2nd intercostal) and axillary placement. He said that as long as it is performed in the apice of the lung you don't have to be precise with it being 2nd intercostal... if its 3rd or 4th its all good as long as u observe correct procedure.

If you cant or dont feel comfortable with anterior placement due to trauma to the anterior chest then I would go for axillary placement. If its a tension then it needs decompressed now. So regardless if its anterior or axillary, it needs done. Of course follow ur protocols and seek medical direction if need be... my protocols do not address location to decompress.

 

[Veneficus]

As far as the comments on the abbreviations, etc... I think they are out of line. People need to understand that the generation of today was brought up with the Internet, texting, hand-held devices, etc. This is all very natural to them and is as common to them as a pencil and paper is to you. It is what it is and they aren't gonna change for you. I understood the OP's questions perfectly.

I agree with your statement, but I would just like to point out that right or wrong, fair or biased, in every English speaking country and a few that aren't, judge a person's intelligence and ability by their proficency with the language.

Poor use of the language can cost opportunities and close doors. Especially when many of the decision makers are still older than I am and in their values, proper language is a must.

Competition is tough, why take any chances that could eliminate you?

If you cant or dont feel comfortable with anterior placement due to trauma to the anterior chest then I would go for axillary placement. If its a tension then it needs decompressed now. So regardless if its anterior or axillary, it needs done. Of course follow ur protocols and seek medical direction if need be... my protocols do not address location to decompress.

In massive pneumo, tension or not, one needle will not be enough, so demanding one specific placement seems like a poor idea.

 

[Firemanfred55]

BLS before ALS, occlusive dressing tape on three sides. If you notice tracheal deviation burp it. If that doesn’t work than go ALS.

 

[JPINFV]

As far as the comments on the abbreviations, etc... I think they are out of line. People need to understand that the generation of today was brought up with the Internet, texting, hand-held devices, etc. This is all very natural to them and is as common to them as a pencil and paper is to you. It is what it is and they aren't gonna change for you. I understood the OP's questions perfectly.

As someone who grew up with the internet (if you remember 14.4 modems as a kid, then you fall into this group), I call BS. When you're communicating on a professional forum open to the public, what and how you write is a reflection both on yourself and the profession you're representing.

As the OP stated, he was typing on a hand-held device where abbreviations make it much easier to get your msg out. If you don't understand the abbreviations then I would recommend you come up to speed.

Strange, my phone is an old flip phone with a standard 12 key touch pad. When I text (I rarely do), I find it no problem to construct grammatically correct sentences with punctuation and full words in a rapid manner. It's not that hard with 12 keys, I can't imagine it's harder with a full keypad smart phone.

 

[Veneficus]

BLS before ALS, occlusive dressing tape on three sides. If you notice tracheal deviation burp it. If that doesn’t work than go ALS.

Can you please tell me the purpose of this statement?

It looks like a reply to my statement that 1 needle is not going to be enough.

In order to treat a significant pneumo definitively, it requires a chest tube, sometimes 2. The common size used is at least 28 french. Which if you convert to Metric is 9.3mm. A 14g catheter is 1.6mm.

That means in order to get the same effect you would need (6) 14g needles because there is no way to insert 5.8 of them. If you were to use a larger french tube like a 32 it would require even more.

Since we know it takes less skill and less time to insert 6 needles into somebody's chest than it does to insert a chest tube for most providers, multiple needles is the choice in the prehospital setting, unless you have an extremely skilled provider putting in the tube. (I have seen senior surgeons do it in about 2 minutes.)

I have also witnessed the placement of a total of (5) 14g needles to the anterior chest in order to obtain clinically significant relief of bilateral pneumos in the field.

 

[Firemanfred55]

Can you please tell me the purpose of this statement?

It looks like a reply to my statement that 1 needle is not going to be enough.

In order to treat a significant pneumo definitively, it requires a chest tube, sometimes 2. The common size used is at least 28 french. Which if you convert to Metric is 9.3mm. A 14g catheter is 1.6mm.

That means in order to get the same effect you would need (6) 14g needles because there is no way to insert 5.8 of them. If you were to use a larger french tube like a 32 it would require even more.

Since we know it takes less skill and less time to insert 6 needles into somebody's chest than it does to insert a chest tube for most providers, multiple needles is the choice in the prehospital setting, unless you have an extremely skilled provider putting in the tube. (I have seen senior surgeons do it in about 2 minutes.)

I have also witnessed the placement of a total of (5) 14g needles to the anterior chest in order to obtain clinically significant relief of bilateral pneumos in the field.

My response was to the initial question. As far as chest tubes in the field, outside of flight medics I haven’t seen that happen. When it comes to multiple 14 or 18g needles I’m fully aware of that.
So relaxes o wise one.

 

[18G]

Tracheal deviation is a late sign and one that is difficult to note in the field especially with a cervical collar in place. There are signs that appear much earlier and are more apparent then tracheal deviation.

I would not rely on trach deviation when deciding to lift the occulsive dressing.