Prehospital Chest Tube Thoracostomy

[kevkei]

With the proper training, why not? We can do surgical crics when the ship hits the fanny, we can do a needle decompression, so why not do it right the first time. Not to mention that a needle is only partially effective in a pneumothorax but does nothing for a hemo(pneumo)thorax.

We decide to needle a chest, they will be getting a chest tube whether we were right on our clinical assessment or not.

As a side note, how about pericardialcentesis too? It's within our scope of practice to do it here.

[Nate]

With the proper training, why not? We can do surgical crics when the ship hits the fanny, we can do a needle decompression, so why not do it right the first time. Not to mention that a needle is only partially effective in a pneumothorax but does nothing for a hemo(pneumo)thorax.

We decide to needle a chest, they will be getting a chest tube whether we were right on our clinical assessment or not.

As a side note, how about pericardialcentesis too? It's within our scope of practice to do it here.

There are services that perform pericardialcentesis around here; and while a chest tube wouldn't be that bad; it is the level of infection that would worry me. Also, our transport times are with in 10 minutes, I think some of the rural services around here could benefit from this though.

[Dustdevil]

Pericardiocentesis was briefly covered in paramedic school (1979), but not as something we were actually expected or allowed to do. My class was nothing but urban firemen. No way would they actually teach them something potentially useful.

Over the next fifteen years, it was something that was always quickly glossed over during refresher courses. Never actually covered in depth. Just by name.

There was no mention of pericardiocentesis in the first paramedic textbook printed (Caroline, 1979). And it remained the same in the last paramedic textbook I ever bought (Bledsoe, 1994). No mention of treatment at all under "cardiac tamponade." The term pericardiocentesis isn't even in the book. Can anybody tell me what current textbooks say about it?

In the mid 80's, the rural hospital based service I worked with had it as a standing order protocol and every medic was in-serviced on the procedure to the medical director's satisfaction, but I don't recall any of us ever using it.

During a paramedic review a couple weeks ago, the instructor again glossed over it, mentioning it by name, but specifically saying, "of course, we don't do that in the field."

What is your procedural protocol for pericardiocentesis in Canadia?

[AZCEP]

In the late '80s/early '90s paramedics in AZ were allowed to perform tube thoracostomy using the McSwain dart. Picture a lawn dart with a shorter tip and you've got it. Several were done, and it was discovered that a pumped up individual could use the dart to secure a patient to an LSB. Yes, I am serious. Back to the 2" 14ga for you.

For pericardiocentesis, it was removed from the scope of practice at about the same time because when the state did a survey on how many had been performed, there weren't enough to justify having it.

[Guest]

we carry everything we need to do it on our trucks but as most you have heard we do not do it in the field, so why carry the kit labeled "Pericardiocentesis Kit".

i was told that "old habits die hard " lol

As far as my textbook i used, i am looking at it right now and am not finding anything. I know that we were told and shown how to do it. We were not able to practice on anything or able to do it should the oppertunity arise in clinical rotations.

we used Essentials of Paramedic Care by Brady. plus many others. but that was the main one

[Ridryder 911]

WHen I first entered the field, it was a lot more common to perform IntraCardiac (IC) injections than EJ IV. Simple technique once you learned the procedure. Then in the late eighties we started placing central lines ( Femoral and sublclavian). I agree, it comes down from the same mind set ... do it right the first time, this also includes education and lab arena to train in as well.

I have placed many chest tubes in and it seem a lot easier than placing a NG tube a belligerant drunk orcatheterizing a 90 year old lady. Again, it just a skill, with having an increased knowledge base, and should be closely monitored.

Be safe,

Ridryder 911

[Dustdevil]

WHen I first entered the field, it was a lot more common to perform IntraCardiac (IC) injections than EJ IV.

Oh man, I remember those days, haha! IC Epi was all the rage around the same time we thought that 500 w/s was a good idea too.

[Ace844]

That's it for responses...!?!?!!? Does anyone think that it's just as efficacious as needle thoracostomy???....

[Ridryder 911]

When performing needle chest decompression the occlusion rate is about 5-7 minutes, before you have to dart again.. some of my patients looked like a porcupine when I arrived. Chest tubes would not occlude as fast... might as do it right the first time....and be done with it.

Be safe,

Ridryder 911

[kevkei]

Does anyone think that it's just as efficacious as needle thoracostomy???....

Nope. It's not.