Needle Decompression

[Flasurfbum]

So I have not gotten a chance to practice this, and only vaguely know how to do this.

Basically, 14 gauge 2 finger breadths below the clavicle, in the intercostal space, lateral of the nipple line?

Who has done one? How difficult are they? Any advice?

[akroeze]

2nd intercostal space, not two fingers breadth.

[akflightmedic]

So I have not gotten a chance to practice this, and only vaguely know how to do this.

Basically, 14 gauge (at least a 2 inch needle) 2 finger breadths (2nd intercostal space just above the 3rd rib)below the clavicle, in the intercostal space, lateral of the nipple line?

Who has done one?

I have maybe once or twice...

How difficult are they?

Can you push a needle into skin? If so, not that difficult, provided you are in the right spot and on the correct side.

Any advice?

Yes.

1. When it is needed, do not hesitate.

2. Make sure you decompress the correct side (had a partner make that error)

3. Continuously reassess. Have had to do multiple decompressions on same patient before (this was prior to us getting chest tubes).

4.Relax, the skills are important but not that important. Anyone can be trained to do them. As we have said before, the education, (AnP, when to do and when not to are more important and impressive than being able to stick a sharp object into a fleshy substance).

[ERDoc]

Good points. Midclavicular line on the correct side. Make sure you are going to the top of the 3rd rib. If you get too close to the bottom of the 2nd you can hit the neurovascular bundle that resides there (A&P at its best).

[p3medic]

A 2" needle in an adult is the bare minimum, I'd suggest finding a 3" catheter.

[akflightmedic]

I didn't want to freak him with the 3.25 I always have readily accessible...

[Kiwiology]

See here http://www.health.wyo.gov/Media.aspx?mediaId=3166

[spenac]

Make sure and go over the top of the rib so you miss the vessels that run under the ribs.

It is amazing how quickly air escapes. I have had flutter valve standing almost straight up. It is amazing how much relief patients almost instantly get.

[firedoc5]

Thought I was going to have to do this with a semi driver, but he was trapped above my head. The truck was on it's side and he was basically crushed in his seat by the steering wheel and dash board. While others were trying to extricate him, a 70 min. job, I was taking care of and monitoring him medically. I got two large bore IV's and luckily he was breathing well on his own. Having to do all this over my head, I was quite relieved it went as well as it did. If it was going to be another 10mins. I knew I was going to have to decompress his chest. But got him out finally and transported him. Had him stable in the ER. Called for Arch Helo out of St. Louis. Actually my partner started transport by ground and met the helo enroute to save time. They just stopped traffic on the Interstate and transferred him to the helo.

Another route we practiced was going to the 5th intercostal space mid-axillary benegnth the arm.

[Ridryder 911]

Ditto to what others have said.. As well, I have had to repeat the decompression because they sometimes occlude off, with time and blood. I have even arrived in ED where they looked like a porcupine..

So yes, been there & done it ......unfortunately more than I would like to think of :roll: