# Pericardial Centesis



## AlaskaEMT (Dec 19, 2008)

Do any of you have standing orders to perform Pericardial Centesis?

If not, should you?  After all, it's part of the H's & T's.


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## Ridryder911 (Dec 19, 2008)

When I first started, it was a standard to administer Epi Intracardiac. It along with many other procedures were determined to be too dangerous. 

As well as performing pericardial centesis is too dangerous, in regards to H & T's; there are many other procedures we are not allowed to do as well as judged to be too dangerous and risky. 

Sometimes, one has to keep thing in perspective.

R/r 911


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## MSDeltaFlt (Dec 19, 2008)

Also, if your pt requires a pericardial centesis, it will be because you are that far down the algorhythm that it will be a last ditch effort.  It is there because it *might* help the pt when a doctor does it.  Basically it is there so that the MD can show the family on paper that everything was attempted to revive the pt.


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## FF894 (Dec 20, 2008)

Many flight programs and critical care programs still have it within their protocol.  I know of at least one occasion when it may have bought some time.


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## reaper (Dec 20, 2008)

Ridryder911 said:


> When I first started, it was a standard to administer Epi Intracardiac. It along with many other procedures were determined to be too dangerous.
> 
> As well as performing pericardial centesis is too dangerous, in regards to H & T's; there are many other procedures we are not allowed to do as well as judged to be too dangerous and risky.
> 
> ...



You know Rid, I get a kick out of the look on a new Emt or medics face, when I explain to them how we used to do intracardiac Epi, with the 6 inch needles!


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## KEVD18 (Dec 20, 2008)

intracardia epi, pericardial centesis along with a hundred other procedures that are both approved and not scare me in the hands of some of the medics on the road today. granted, they are probably in the minority; but i have heard about, read about, worked with and qa'd many medics who imho shouldn't be practicing at the chair van driver level, much less as als providers. giving them a 6 inch needle and telling them to pulp fiction a guy frightens me to the core.


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## VentMedic (Dec 20, 2008)

It is still in our Flight program protocols.  I've done the procedure twice in the last 10 years.   

No. You do not need to use a spinal needle.


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## jochi1543 (Dec 26, 2008)

I don't think it's in the ALS scope here.


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## medic417 (Jan 4, 2009)

Yes it should be in our protocols.  If a patient is that far down they will die w/o relief of that pressure.  Might die anyway but at least give them a chance.


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## Kendall (Jan 4, 2009)

jochi1543 said:


> I don't think it's in the ALS scope here.



I'm almost certain its in the protocals but I don't think any medical Director in AB would allow it to be done, even the "great" Dr. Sukram...


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## eric2068 (Jan 5, 2009)

That is out of scope of practice in our state, and to be honest, in 19 years of EMS, I haven't seen too many tamponades. Still, it would be nice to have just in case. It would require regular trainings to keep skill levels up. Our training officer would love that.


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## rhan101277 (Jan 5, 2009)

VentMedic said:


> It is still in our Flight program protocols.  I've done the procedure twice in the last 10 years.
> 
> No. You do not need to use a spinal needle.



So you just knew the procedure like the back of your hands? I worry about forgetting stuff, but I guess confidence comes with experience.


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## MSDeltaFlt (Jan 5, 2009)

rhan101277 said:


> So you just knew the procedure like the back of your hands? I worry about forgetting stuff, but I guess confidence comes with experience.



Rhan,

The only way you'll ever be able to perform this procedure at an ALS level is to leave our great state and move to one that will allow it.  We might not be in the Dark Ages, but the light is still pretty dim.


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## medic417 (Jan 5, 2009)

Honestly paramedics should get higher education and this should become a standard skill in the field.  At this point though many paramedics probably can not even recognize it correctly.  How many paramedics even know what the correct heart sounds are?


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## MSDeltaFlt (Jan 5, 2009)

Usually the ones who have done this procedure have done it only a *few* times in their *long* careers at a *teaching facility* or at a place that has a *high volume* and/or a *high accuity rate*.  They are the *one time out of 100*.  Because the other *99 times out of 100*, it is a last ditch effort that proves on paper to the pt's loved ones that you did everything you could to keep them alive, and they still got DTJ (Discharged To Jesus).


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## VentMedic (Jan 5, 2009)

rhan101277 said:


> So you just knew the procedure like the back of your hands? I worry about forgetting stuff, but I guess confidence comes with experience.


 
We review procedures with our medical director. Some are reviewed every 6 months and some yearly.   Chest tubes, crics and central lines are a few of the skills reviewed but, hopefully, rarely needed.   Intubations, IVs, meds and the principles of the technology are areas of concentration which should be as familiar as the back of your hand.   

Those of us that are hospital based or work in the hospital such as  in Flight team members (RNs, RRTs, EMT-Ps) are more familiar with with a procedure such as pericardial centesis since it is done on occasion in the ICU or ED. 

As already mentioned, Paramedics did a lot more procedures 30 years ago but medicine evolved with evidence based studies and trauma centers appeared.  Some of those procedures are no longer necessary for the field.   

Examples: The IO made field central lines unnecessary.  Intracardiac epi was found to have little effect on survival. Pericardial centensis may also be of little relevance in the field depending on the age, overall health of the patient and mechanism causing the pericardial sac to fill.


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## medic417 (Jan 6, 2009)

VentMedic said:


> We review procedures with our medical director. Some are reviewed every 6 months and some yearly.   Chest tubes, crics and central lines are a few of the skills reviewed but, hopefully, rarely needed.   Intubations, IVs, meds and the principles of the technology are areas of concentration which should be as familiar as the back of your hand.
> 
> Those of us that are hospital based or work in the hospital such as  in Flight team members (RNs, RRTs, EMT-Ps) are more familiar with with a procedure such as pericardial centesis since it is done on occasion in the ICU or ED.
> 
> ...



But still to have it available in rural areas could be very valuable.  Plus the additional education would also be a plus in EMS.  Not just a few hour card course but an in depth class to better understand the hows and whys.


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## VentMedic (Jan 6, 2009)

medic417 said:


> But still to have it available in rural areas could be very valuable. Plus the additional education would also be a plus in EMS. Not just a few hour card course but an in depth class to better understand the hows and whys.


 
Some of the HEMS that responds to the rural areas do have the ability to do this procedure. However, a helicopter shouldn't be called if the patient is "dead". There are some services where the helicopter is dispatched immediately with the ambulance by PD.

I do know of a few rural EMS ground services that do perform it. ADA County is often mentioned on another forum.   Their protocols are on their website.
http://www.adaweb.net/

http://www.adaweb.net/Paramedics/Pages/SWOTableofContents.aspx


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## medic417 (Jan 7, 2009)

VentMedic said:


> Some of the HEMS that responds to the rural areas do have the ability to do this procedure. However, a helicopter shouldn't be called if the patient is "dead". There are some services where the helicopter is dispatched immediately with the ambulance by PD.
> 
> I do know of a few rural EMS ground services that do perform it. ADA County is often mentioned on another forum.   Their protocols are on their website.
> http://www.adaweb.net/
> ...




Thanks for the link.


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