pericardiocentsis
- Thread starter shafal8
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Yes, with proper indication and training.
No you do not have to be CCEMT-P, Paramedics with proper training can perform this skill. There are services in the US who do this skill in the Field.
Why? Because Pericadial Tamponade is a reversable cause of PEA, and we do the most we can with what we have for a patient before we pronounce. Ineffective Chest Compressions enroute to the ER going lights and sirens for a pericardiocentsis is not going to have a favorable outcome. If they need the procedure, they need it done where they lay and quick.
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NomadicMedic
I know a guy who knows a guy.
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It was taught in my paramedic class and many services still do it.
For example, here's a screen shot of the Pierce County WA protocols.
Should paramedics be routinely performing this skill in the field? Probably not.
For example, here's a screen shot of the Pierce County WA protocols.
Should paramedics be routinely performing this skill in the field? Probably not.
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No (including flight and CCT).
Anjel
Forum Angel
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Our flight medics can and in pretty sure the CCTs can.
Not every pneumothorax needs a field needle decompression but at the point of tension pneumothorax they do.
Same argument can be applied
Not every pericardial effusion needs a field pericardiocentesis but at the point of cardiac tamponade (positive Beck's triad) they do.
Yes proper training, yes proper equipment, yes ultrasound.
Same argument can be applied
Not every pericardial effusion needs a field pericardiocentesis but at the point of cardiac tamponade (positive Beck's triad) they do.
Yes proper training, yes proper equipment, yes ultrasound.
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VFlutter
Flight Nurse
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For traumatic cardiac arrests? Maybe, I don't think it's practical. Other than that absolutely not. How often do you encounter tamponade w/ cardiogenic shock? You might be able to make an argument for Flight/ CCT but I would rather have the Flight RN doing it since most have extensive experience with the procedure in the ICU.
Any examples of protocols?
I do not see anyway non CCT medics could stay competent to perform the procedure outside of arrests. Especially without ultrasound guidance.
Handing the doc the equipment and watching a handful of times is not extensive. And if the RN actually has "extensive" observational experience, I do not see how they'd be that much more appropriate than a medic. But, regardless... very very few would have the procedure indicated and many many fewer would potentially benefit, especially in trauma.
NomadicMedic
I know a guy who knows a guy.
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I posted a screen shot above. Allowed at the services I worked at. I've done one at a trauma arrest. Had no effect on outcome.
DeMedic Posted one, King County does(I believe), Williamson County EMS does. In the presence of a traumatic arrest. I do commonly hear of systems stating in their protocols "Bilateral Needle Decompressions prior to pronouncement of Traumatic Arrest" Some systems have also added Pericardiocentesis to that.
Smaller system who work closely work their Medical Directors and train on the procedure throughout the year.
When I say smaller, I mean these systems are no LA, SD, Ft. Worth, Dallas, Houston, etc etc...
Excuse my little experience with ICUs here, but ICU Rn's doing this in the ICU? I have never seen a nurse perform this skill. Only Doctors, and of the Doctors I have seen it was half and half that used Ultrasound.
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h34r:So, then why the power points, lectures, stabbing dummys, or whatever every year when it is almost never done and is more than likely to have no effect at all even in patients that actually have tamponade.
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Prehospital pericardiocentesis is a "look - I'm a better paramedic because I have cool skills in my protocols" intervention.
Similar to RSI. But at least you can make a good argument for RSI.
Similar to RSI. But at least you can make a good argument for RSI.
Other things aside are you suggesting that pericardiocentesis has very little or no effect in patients who actually have a tamponade?
For trauma? Yes.
VFlutter
Flight Nurse
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No RNs do not physically peform the procedure but they assist. It's usually the CCP or CT surgeon doing them. Personally, I have seen 2 emergent and a few scheduled over the past 4 months. As pointed out above the experience assisting really isn't all that valuable but it's still better than nothing.
I have never seen a trauma induced tamponade. Most have been s/p CABG, pericarditis, or malignant effusions. A couple ended up with a window and mediastinal tube.
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Are we supposed to not to perform skills in the field based off of there regularity?
If that was the case we would not do surgical airways either...
While I know Surgical airways obviously have a higher potential for success and positive outcome, I was strictly using that as a comparision for low use skills.
We all know the chance of the procedure is slight, however there are plenty of documented cases of it being effective and working. Still more NOs than YESs. However, it really does come down to this is a last ditch effort to save another human's life prior to pronouncing them dead.
For the record, I have never performed either of these skills mentioned in the field on a human. Only in training on Dummys and animals.
When a Medical Director places this in a systems protocols, I don't think that was the thought they had running through their mind when they did it.
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Can you provide any literature or studies that support this? (By trauma I assume we are not talking traumatic arrest, but trauma in general)