Needle Chest Decompressions and Pneumothorax

[Doc D]

Palpating ribs, guess im gonna have get some more practice. the angle trick is pretty interesting also, will look into it. I have another question? What is the effectiveness of a flutter valve on pneumothorax? putting an occlusive dressing on the exit wound in the back, and putting one on the front but leaving the bottom open for air to flow out and sitting the patient up-straight

[tskstorm]

Only on kids.

One of the bigger mistakes in doing this proceedure is not using a long enough needle. Here we cary 10 g , 3 1/4 needles for this very reason, although there are some really obese patients you may not hit the pleural space even then.

Steve

I was joking, and my 1/2 I meant .5 not 1 or 2 inch...

[Dustdevil]

Palpating ribs, guess im gonna have get some more practice. the angle trick is pretty interesting also, will look into it. I have another question? What is the effectiveness of a flutter valve on pneumothorax? putting an occlusive dressing on the exit wound in the back, and putting one on the front but leaving the bottom open for air to flow out and sitting the patient up-straight

Theoretically, it's sound. However, there are a few problems in actual practice. First, by the time you get to them and start applying the dressing, they often already need decompression. A flutter valve only prevents progression (if you're lucky). It doesn't reverse the process. Second, the Asherman's have a tendency to clot off, defeating the flutter valve function. Consequently, unless you are very, very close to definitive care, it's often that you will still need to dart.

[billygoatpete]

Nothing to add in the landmark department as I think it's been fairly well covered above...

I will add a little tip that wasn't taught to me until after I had already done a couple decompression's...I have found it to make the procedure go a little smoother.

Prior to doing the actual decompression, make a small "nick" in the skin at the point in which you will insert the needle. You can do this with the tip of your needle (or a scalpel if you have one and the time) it doesn't need to be very big or very deep, just enough to get into the dermis. In my experience, this small "nick" decreases resistance while inserting the needle and has made the procedure go a bit smoother.

Of course, prior to doing this, make sure that the extra step is covered in your treatment guidelines, if it's not, you might have a chat with your medical oversight to consider adding it.

Good luck and THANK YOU for your service to our country!

[tskstorm]

You see a lot of patients with need for NCD? I've seen it once and I work in a very busy system. (NYC EMS)

[HERBIE1]

You see a lot of patients with need for NCD? I've seen it once and I work in a very busy system. (NYC EMS)

Depends on your system and protocols. First, our system is also urban and very busy, but very slow to adopt new ideas- or eliminate those that do not work. Many systems do not transport traumatic arrests if they meet certain criteria(besides the usual decomp, decapitation, rigor, etc)- ours does not allow for that. One of our protocols is to bilaterally needle decompress traumatic arrests. I've done dozens of them.

[1EMT-P]

I would encourage you to practice your palpation skills as much as possible, also please don't forget that you need to have a 10-14 ga IV cath 2" in length.

[tskstorm]

Depends on your system and protocols. First, our system is also urban and very busy, but very slow to adopt new ideas- or eliminate those that do not work. Many systems do not transport traumatic arrests if they meet certain criteria(besides the usual decomp, decapitation, rigor, etc)- ours does not allow for that. One of our protocols is to bilaterally needle decompress traumatic arrests. I've done dozens of them.

Cool, we don't do it here, practically ever.