Needle Thoracostomy Help

[JMedSim]

Hello All,

I am a medical software developer working to create a comprehensive training simulation in hyperbaric medicine for EMT's and Nurses. One of the many topics in our simulation is the diagnosis and treatment of a tension pneumothorax by performing a needle thoracostomy. I am wondering where in this emergency procedure do EMT students run into problems and in which step do complications arise? For example, is it trying to insert the needle at the correct angle, not penetrating the pleural space, or clogging of the catheter etc? Also, what are the pre-op procedures that an EMT must do before inserting the needle?

Any help from those with clinical experience is greatly apreciated. You can contact me by posting on this blog or sending me a direct e-mail at JMintzer.MedSim@gmail.com.

Best,

Jacob

[p3medic]

Hello All,

I am a medical software developer working to create a comprehensive training simulation in hyperbaric medicine for EMT's and Nurses. One of the many topics in our simulation is the diagnosis and treatment of a tension pneumothorax by performing a needle thoracostomy. I am wondering where in this emergency procedure do EMT students run into problems and in which step do complications arise? For example, is it trying to insert the needle at the correct angle, not penetrating the pleural space, or clogging of the catheter etc? Also, what are the pre-op procedures that an EMT must do before inserting the needle?

Any help from those with clinical experience is greatly apreciated. You can contact me by posting on this blog or sending me a direct e-mail at JMintzer.MedSim@gmail.com.

Best,

Jacob

I would say insufficient catheter guage and length are the two biggest issues. I would suggest a catheter of no less than 3" and no smaller than 14g in the adult. Also, using a lateral approach seems to provide better access (less tissue) than the anterior approach.

[spenac]

Correct identification of proper placement location. Clogging and realizing it has occurred, so they need to recognize need to dart a second or third time. And I agree that they need to understand it takes a long cath to do the job on most adults. They need to develop proper cleaning techniques.

[VentMedic]

The complications will be dependent upon what stage you are at during the dive or if this is before or after. One must recognize that different treatment such as an indwelling catheter or tube must be inserted because the needle will not be enough no matter how many holes you poke in the chest. One may also have to decide whether recompression might be necessary to safely do the procedure.

The outlines and material recommendations from the NBDHMT give the specific guides and procedures for HBO. There are more considerations and concerns for those working in dive medicine or HBO which is why even Doctors and Paramedics must take the courses to fully understand the differences. If you are designing this program for those about to take the certification exams or who plan on working with HBO chambers, it would be best to follow the material since this is a specialty.

[JMedSim]

If you take the lateral approach, would you still use the 2nd intercostal site for you insertion point?

Hi All,

I appreciate everyone's responses. I agree that cathether gauge and size are key steps as well as the ability to recognize clogging. In addition, I will do further research on NBDHMT to see their specific guidelines. Is there an easier way to locate the correct insertion site? I am sure that body size, weight, and age play a factor.

Best,

Jacob

[FireMedic65]

Do we get said software to play around with for free?

[p3medic]

If you take the lateral approach, would you still use the 2nd intercostal site for you insertion point?

No, you would use the 4th or 5th ICS, same for cx tube placement.

[JMedSim]

Dear All,

Your feedback was extremely helpful. Are there any other emergency procedures that you would like to see turned into virtual training simulations?

Best,

Jacob

[mobey]

Dear All,

Your feedback was extremely helpful. Are there any other emergency procedures that you would like to see turned into virtual training simulations?

Best,

Jacob

Transport ventilator management.

chest tube management.

Interosseous infusion.

How about the management of a complicated patient? If you read the "scenario's" section of this forum, there are some good examples. I have used trauma.org's moulages for practice, but they have yet to add any new ones in years.

For us rural Paramedics, access to some interactive up-to date scenario based software would be a real asset and could be a very profitable enterprise for a software entrepreneur.

Just a thought

Mobey

[VentMedic]

Transport ventilator management.

For ventilator management, it is best you get the training video directly from the manufacturer along with a rep.

This is a decent one for the LTV 1200 since it is the national disaster vent of choice.

http://www.aarc.org/education/webcast_central/archives/2009/09_22_2009_ltv_1200.asp

While "numbers" may look the same in the generic literature, they do no always translate well to the many different pieces of technology out there. Too often CCT and Flight teams get the patient into trouble by just matching the numbers while not understanding the vast differences in the equipment.

This also goes for the many different chest tube devices. Each device might have a different application such as those preferred for HBO, Flight or ICU. And, each of those specialties will use many different types of devices.

For HBO, hands on is definitely the best especially if you have a chamber to where you can set up the equipment. The portable vent you use with HBO may not be used in other places as we may have different pressure adjusting vents. We will use cadaver labs and practice on ICU patients for many of the invasive procedures such as chest tube insertion before working with HBO patients.

Edited March 9, 2010 by VentMedic