Needle decompression in crashing status asthmaticus

[VentMedic]

Well in Australia is it not common practice to essentially squeeze the chest to aid in getting air out?

Apparently it is according to some of the references.

I may have to search the ERS, the Australian/NZ Thoracic Society and Respiratory Science sites later for more info.

[BushyFromOz]

Well in Australia is it not common practice to essentially squeeze the chest to aid in getting air out?

Yep, moderate lateral chest pressure is usually enough to squueze some air out of them, even written into our guidelines. Basically with TPNT for our guidelines, some of your normal signs and symptoms with rapid deteriation of consciousness and and perfusion, we can decompress. If we are unsure we have the option to test with a 22g needle and some saline in a 10ml syringe and see if we can aspirate a large amount of air. JVP distension, low perfusion and maybe hypotension you'll see, but you wont get sub cut emphysema or tracheal shifting, and chest thrusts wont work on a TPNT. Generall, if they are going to tension it happens well before we get there anyway. Brick bag and ineffective chest thrusts with some sub cut emphysema and rarely a tracheal shift.

Quick reply, but im off to work christmas aprty

dont get pissed with my spelling mike :D:D

[crotchitymedic1986]

Neither lung is working well, lets poke a hole in one of them. You need medication and intubation, needles do not create elasticity.

[Arctickat]

There is some research ongoing for manually (or machanically) decompressing the chest externally but nothing conclusive at this time.

I've heard of this for COPD patients, does it work on asthma as well? I didn't think it would because of the different mechanism involved.

[firedoc5]

To me it sounds like it's easier to treat the asthma itself before tapping the chest. I don't think I've seen an actual tension pneumo from asthma. Now I know of spontaneous simple pneumo's in asthma pts. My cousin was one. Luckily he was already in the hosp. and it didn't get to tension.

I'd say if you do have to bag them, just be cautious and pay attention to resistance on ventilating. If the bagging tends to start being harder, slow down on the vents.

[VentMedic]

I've heard of this for COPD patients, does it work on asthma as well? I didn't think it would because of the different mechanism involved.

We use a high frequency chest compression device to assist in mobilizing secretions and hopefully unblock a few airways. However, this is in conjunction with meds, bronchodilators and anti-inflammatories. It is not always well tolerated in the acute exacerbation. If hypoxia is not a major issue, we may give it a try initially. Since the V/Q mismatching is due to the inability to get O2 with ventilation to the lower airways, heliox is very effective and often the 80/20 (He/O2) or 70/30 mix will be adequate for oxygenation. Occasionally more O2 may be required if there is a PNA or cardiac involvement.

IPV, Intrapulmonary percussive ventilation, can also be useful for acute and maintenance.

Heliox is readily available in the majority of our EDs and transport times are relatively short in my area so we can get the advanced technology going quickly. We also have many different nebulizers in the ED that can enhance particle deposition.

[Arctickat]

Hmm, Heliox huh? One more excuse to carry my scuba gear on calls Wonder if I can get orders for that. lol

[p3medic]

Unfortunately the tank is HUGE! It would be nice if you could carry it in a D tank.

[VentMedic]

Unfortunately the tank is HUGE! It would be nice if you could carry it in a D tank.

True. When running Heliox 80/20 mix, if your flowmeter says 10 L/m it is really using 18 L/m. It can use up even an H tank rather quickly.

http://www.rcjournal.com/contents/06.06/06.06.0651.pdf

[spenac]

True. When running Heliox 80/20 mix, if your flowmeter says 10 L/m it is really using 18 L/m. It can use up even an H tank rather quickly.

http://www.rcjournal.com/contents/06.06/06.06.0651.pdf

Vent thanks for the education. These are the types of things I enjoy seeing from you. Sorry I have gotten sideways with you on a couple of topics lately.