A question on a question on a quiz

arharris83 said:
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.
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As others have said. Also, C almost works except why would I pull a cath first and then insert a larger bore cath? Even if the larger bore cath is a chest tube, it doesn't make any sense to me to pull the other cath until later, so that's out as the "answer".

If you're putting a chest tube in and you have no means to provide suction, that one-way valve makes sense, but the trachea is still going to be a larger bore hole than the chest tube, so even if you forget the valve, you won't get much air inflow through the tube.

I also know how/where to place a chest tube, but I would most certainly hope that I'd get formal in-serviced on that procedure if I were to be authorized to do it... otherwise it would probably look like I attempted the procedure with a chainsaw. :ph34r:
 
When you see your pt needing needle decompression, You dart 'em. If you he needs it again, you dart again... and again... and again if he repeatedly shows sign of worsening pneumo. Role that pt in the ER with his chest looking like the flag staffs at the UN if need be.
 
Upon reading again, I noticed several people comment on the flutter valve.

My experience was we stopped worrying about those circa 2002 or so. They are not needed and I was pretty sure PHTLS got away from teaching this around that time period.

Anyone that can comment with references is appreciated.

I searched to try and validate what I seem to be recalling and so far all I have is this document, please note page 16.

http://www.health.mil/Libraries/101...ls/0603_CoTCCC_Meeting_Minutes_0807_Final.pdf
 
It's been my experience that with a "tension" pneumothorax you wouldn't need a one way valve. Since the definition of the term indicates that there is more pressure in the pleural cavity than outside the pleural cavity, a one way valve Would be redundant.
 
MSDeltaFlt said:
It's been my experience that with a "tension" pneumothorax you wouldn't need a one way valve. Since the definition of the term indicates that there is more pressure in the pleural cavity than outside the pleural cavity, a one way valve Would be redundant.
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When has redundancy or inefectiveness ever stopped a traditional EMS practice?
 
I'm going with "B" in my protocols we're taught upon identifying a tension pneumo, to decompress if no improvement go 1cm lateral and decompress again, and again and again..... Until some improvement is noted, one way valve has been taken out awhile ago as far as im aware. I've done 3 decompressions in last 2 months first was a PVA second was GSW and third Motorbike accident. 2 showed rapid improvement, Motorbike accident unfortunately did not show much improvement even with 3x 14ga inserted.
 
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