Prehospital Chest Tube Thoracostomy

[Letterman]

It has been said previously, "We decide to needle a chest, they will be getting a chest tube whether we were right on our clinical assessment or not." And " As a side note, how about pericardialcentesis too? It's within our scope of practice to do it here."

Hmmm... as far as the National Occupational Competency Profiles Curriculum for Canada's Paramedics that sits in front of me, pericardicentesis is not done in Canada or any one of its Provinces or Territories. It is not approved as a paramedics scope of practice by the Canadian Medical Association or any College of Paramedics, Physicians, Surgeons or the like. Unless Dr. Kavorkian is back in business and is serving as your base hospital physician you do not want to advertise that you have a scope of practice that includes pericardicentesis. One stabb and your in the bighouse defending why you poked a patients heart as a paramedic. And how often does a paramedic come across cardicardial tampanade? And we are supposed to maintain the competency how?

Respectfully from Ontario

[Guest]

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.

[hr:f2320c4134]

Ok Alberta lets try again, anonimity really does not give literary licence to go OVER the edge, I think you mean percutanous or pseudo surgical trach's, a cric is not intended to be surgical I hope, perhaps needle cric....maybe this is the medical term that your stumbling for.

Stumble on Dude!

I believe you should give C+C a call, do you remember that waiver you signed in ACLS? Its quite clear that unless your local medical authority autherises and provides you with the appropriate tools.. you are b__ls__ing.

The tool is called a cooks needle by the way...got one in your bag of tricks? I doubt it very much.

Now, in regards to a traumatic arrest from pericardial tamponade, hmmm, Stats are, traumatic arrest in the field is 98% against resus, this blind procedure is the coupe de gras, excuse my french its poor. If you are suggesting that a pericardiocentesis is indicated from a pericarditis from a field evaluation.....frankly your scaring the crap out of me.

Now on to Chest Tubes, now if your not "RIGHT ON" with your clinical assessment, its time to do a ride along with a knowlegable Paramedic, a Tension Pneumo screams at you!!!Further not all pneumos (small) need to be decompressed, unless you have to go flying, treat with O2 they will absorb if one displaces nitrogen with O2. Now on to interpretation of CXRay it is not in CBO for an ACP in Alberta, well YET! But niether is the Critical Care level, why not billy, what are we waiting for a NEW registrar, i digress again silly me.

So without this definitive diagnostic confirmation of said pneumo/hemo to confirmation of effective placement and the evaluation of said pathology.

Now you may not know the true pmhx in alberta here as you really sound like a new grad. but during the jurrasic period Paramedics did in fact place tubes in ALTA....until someone did not recognise that one entered a 14 yr old boys liver, do I have to explain any further. now some constructive advice, use a 10 gauge for decompresion of pneumo, hemo and your crics as well, go big or go home. ps pin cushions/hedgehogs do survive hemos, pt. position is very important.

There is a real reason to push the recognition of CCP and adopt national standards, its time for Alberta to play catch up now, we cannot sit back on our asses and think we are the best, time to get at it, new leadership is the key.

[Letterman]

This 'Squint' guy makes sense Alberta! I wonder if he's been around for a while and knows the in's and out's of paramedicine. Probably a guy who you should discuss your Albertan related conclusions with before embarressing the medics there. If pericardicentesis is in your skill set, I'll match that and raise you an onscene heart transplant. Ontario medics have been doing them for years and carry an extra pigs heart on ice in the bus for just such an occassion. I'll admit that I'm bluffing if you will.

[Guest]

Squint, exactly what province is "the wind" in?

Opps; I that should read I have wind!

[Dustdevil]

Opps; I that should read I have wind!

Is that your cute way of saying you're not going to tell us where you are? :?

If you're going to go on and on about how things are where you are, it would be polite to at least tell us where that might be.

[Guest]

dusty dude:

I thought that may become obvious after last post, I play in B.C. NWT. Caribbean ++ but reside in the Canadian equivalent of northern Texas namely Alberta.

New to this forum stuff although fairly active on sites that anonymity is not respected and honesty in opinions are appreciated at face value.

I believe in keeping things in the reality zone, as from your posting do you.

But am quite envious that Letterman can do Heart transplants....wow hes good!

as yourself I have been in the biz for quite some time.

[fireresque51]

ok its my first night as a member but here I go.

Tennessee is starting a new license class CC Paramedic, included in the training is chest tubes, and the skill will be added to the scope of practice here. The service I work for is a small county (only about 7000 runs a year) but we have long transport times and have adopted very aggressive protocols, and we are planning on adding the procedure to our standing orders.

I think in rural settings it can be a very beneficial treatment, we currently use the cook kits with the melker valve that we hook to suction, we do needle cric's and RSI, but we also mandate 118 hours of inservice every year plus credentialing and mandatory refresher every 2 years. So as long as the training is in place and the QI why not.

[Dustdevil]

Squint, I don't have a problem with anything you have posted. It is obvious that you are seasoned and knowledgeable. It just adds a lot of perspective knowing where you are coming from. And simply listing the province you are from is FAR from revealing any sensitive personal information that might be crucial to your anonymity, unless you are one of maybe three medics in all of the NWT. Thanks for the info.

[Guest]

ok its my first night as a member but here I go.

Tennessee is starting a new license class CC Paramedic, included in the training is chest tubes, and the skill will be added to the scope of practice here. The service I work for is a small county (only about 7000 runs a year) but we have long transport times and have adopted very aggressive protocols, and we are planning on adding the procedure to our standing orders.

I think in rural settings it can be a very beneficial treatment, we currently use the cook kits with the melker valve that we hook to suction, we do needle cric's and RSI, but we also mandate 118 hours of inservice every year plus credentialing and mandatory refresher every 2 years. So as long as the training is in place and the QI why not.

Well good start man: Your service sounds quite progressive, your QA program sounds great...very similar to your northern cousins...... is it a private or public based service sounds like fire based?

This is what is needed not cowboys but evidence based medicine but be a sport and keep us all up to date, and can you provide a link for this technique I don't think I have seen this melker valve, but then we measure temperature in C and use funny colored money. I know that doing studies is a ton of work, but scientific proof is the way to forward this profession, it is not just a tech job or applying the cook book mentality.

look forward to hear of any progress pro or con and your link.

Thanks

[Dustdevil]

Hey 51, is it true that EMT-I is the mandated entry level for EMS in Tennessee? I heard this and I think it sounds too wonderful to be true!