A question on a question on a quiz

[firemedic0227]

So I had a test the other day that had a question something along the lines of ... You have successfully Needle Decompressed a Tension Pneumothorax showing equal and bilateral lung sounds. After a few seconds you see your SpO2 level at 83% and you no longer hear lung sounds on the Needle Decompression side. Should you ...

A. Remove the Catheter and occlude the puncture site
B. Add another Catheter near the orginal Catheter
C. Pull Out that Catheter and insert another larger bore Catheter
D. Decompress the other side of the chest

I don't remember reading anything about this or hearing anything about this while in Medic Class. I went back to my text book and can't find anything on it either.

 

[JPINFV]

"Insert chest tube" strangely missing...

 

[Handsome Robb]

JP last time I checked medics can't place chest tubes.

The answer is B. I'm surprised you didn't go over that in class...I'm also assuming your original catheter was fitted with a one way valve as well...

 

[STXmedic]

Leave in initial cath. Decompress again, typically just lateral. Pretty sure that's what they're looking for.

 

[JPINFV]

JP last time I checked medics can't place chest tubes.

Well... yes... but... h34r:

 

[firemedic0227]

JP last time I checked medics can't place chest tubes.

The answer is B. I'm surprised you didn't go over that in class...I'm also assuming your original catheter was fitted with a one way valve as well...

Now that I it's been mentioned to me on here I do remember going over it in class (when I was in PHTLS 4 months ago). That's what I thought it was but I decided to go with C instead for some reason.

 

[Handsome Robb]

Now that I it's been mentioned to me on here I do remember going over it in class (when I was in PHTLS 4 months ago). That's what I thought it was but I decided to go with C instead for some reason.

If you really wanted to get technical we don't remove impaled objects unless they directly interfere with the airway h34r:

Well... yes... but... h34r:

With that said, do I know how to place one? Yes. Would I feel comfortable doing it on a live person without direct supervision? Not really.

 

[firemedic0227]

If you really wanted to get technical we don't remove impaled objects unless they directly interfere with the airway h34r:


Well when you think about it that is very true ... haha.

 

[usafmedic45]

"Insert chest tube" strangely missing...

That's what I was thinking too. LOL

 

[JPINFV]

If you really wanted to get technical we don't remove impaled objects unless they directly interfere with the airway h34r:

If you want to get technical like that, paramedics, and EMTs remove impaled objects all the time...


...like lancets for checking BGLs.

 

[JPINFV]

That's what I was thinking too. LOL

Sometimes I fantasize about going to another EMS forum (plenty out there where this would work), signing up as an "EMT" (since I have been trained as an EMT), and posting a physician level workup and management just for the lulz.

Yes, I have a queer* sense of humor at times.

*I'm reclaiming this word for the rest of society.

 

[Handsome Robb]

If you want to get technical like that, paramedics, and EMTs remove impaled objects all the time...


...like lancets for checking BGLs.

Touche salesman!

 

[usafmedic45]

I'm also assuming your original catheter was fitted with a one way valve as well...

I've never understood the need for a one-way valve on an angiocath used for this purpose. It's so much smaller than the trachea that you're not going to get a preferential inflow of air through it unless the airway is obstructed. It's one reason I was always taught to not freak out about (but not to ignore) and opening in the chest that is smaller than 2/3 the size of the trachea. If it's smaller than that and they've got a tension pneumo, it's because of the internal damage (lacerated large airway being high on the list) or you've missed another, large wound to the chest wall.

Now that I it's been mentioned to me on here I do remember going over it in class (when I was in PHTLS 4 months ago). That's what I thought it was but I decided to go with C instead for some reason.

Just remember that you're trying to increase the amount of space through which this air can escape. Pulling the first catheter is not going to accomplish that.

 

[akflightmedic]

JP last time I checked medics can't place chest tubes.

The answer is B. I'm surprised you didn't go over that in class...I'm also assuming your original catheter was fitted with a one way valve as well...

It is answer B, but you are incorrect on this next part...Medics can and do place chest tubes. All depends on your service, your state and your med director of course.

 

[JPINFV]

It is answer B, but you are incorrect on this next part...Medics can and do place chest tubes. All depends on your service, your state and your med director of course.

However, I would be willing to bet that the number of civilian paramedics in the US who are allowed to place chest tubes are vastly outnumbered by those who can't.

 

[usafmedic45]

However, I would be willing to bet that the number of civilian paramedics in the US who are allowed to place chest tubes are vastly outnumbered by those who can't.

I can tell you that the number of civilian paramedics I would trust to put in a chest tube is vastly outweighed by the number I wouldn't give anything sharper than a tongue depressor.

 

[STXmedic]

I can tell you that the number of civilian paramedics I would trust to put in a chest tube is vastly outweighed by the number I wouldn't give anything sharper than a tongue depressor.

Sasha says "Come here, USAF..."

 

[Smash]

I've never understood the need for a one-way valve on an angiocath used for this purpose.

Oh god, amen to that! It is an obsession where I work, and all it ever does is add more crap to a messy scene and give people more distractions from important tasks. Make the hole, move on. Hell, blunt finger dissection does the job just as well in the first instance.

 

[Handsome Robb]

I've never understood the need for a one-way valve on an angiocath used for this purpose. It's so much smaller than the trachea that you're not going to get a preferential inflow of air through it unless the airway is obstructed. It's one reason I was always taught to not freak out about (but not to ignore) and opening in the chest that is smaller than 2/3 the size of the trachea. If it's smaller than that and they've got a tension pneumo, it's because of the internal damage (lacerated large airway being high on the list) or you've missed another, large wound to the chest wall.

I always wondered about this. What you said definitely makes sense. From what I hear, we get reamed if we don't use one though.

It is answer B, but you are incorrect on this next part...Medics can and do place chest tubes. All depends on your service, your state and your med director of course.

Fair enough. I was taught to place them but like I said I wouldn't feel comfortable doing it without doing a live one with a higher level provider looking over my shoulder for the first time. Also, I think usaf may come after me with a scalpel or other sharp object so for the time being I'll stay away

Where I work only Flight Nurses can place them.

If you want to get technical like that, paramedics, and EMTs remove impaled objects all the time...


...like lancets for checking BGLs.

I thought of another one, Taser darts. Service dependent though.

 

[usafmedic45]

Also, I think usaf may come after me with a scalpel or other sharp object so for the time being I'll stay away

If you're trying to point out that I don't trust you, you're mistaken. LOL

From what I hear, we get reamed if we don't use one though.

I had a doc try that once and I told him to show me where there was any scientific data to validate the practice. Stopped him dead in his tracks....