How prevalent are tension pneumo's?

[kb2468]

Anyone have a good idea of how frequently tension pneumothorax's occur?

Trying to do some research on how often it's seen in active duty, and what kinds of needles people tend to use (or even have on hand just in case) in treating it.

Thanks!!
kb

 

[lightsandsirens5]

Compared to the number of people we transport, very rare.

And you ain't never going to see one unless you are providing PPV.

As for treating one, what I have seen fairly frequently is a 14, 12, or 10 ga needle with a very long cath. (Somewheres around 3 inches.)

 

[medicsb]

Pretty rare.

Prehosp Emerg Care. 2008 Apr-Jun;12(2):162-8.
Paramedic use of needle thoracostomy in the prehospital environment.
Warner KJ, Copass MK, Bulger EM.

Seattle Medic One performed 39 in a one year period. 22 were in cardiac arrest (10 being trauma and the others being PEA arrests). All but one of the remaining were trauma. Of those not in arrest only 6 had both hypotension and decreased breath sounds. 8 seemed to be simple pneumos
--

Prehosp Emerg Care. 1998 Apr-Jun;2(2):132-5.
Needle thoracostomy in the prehospital setting.
Eckstein M, Suyehara D.

108 patients in a 1 year period at one level 1 trauma center in the LA area.
2 were found to not have reached the pleural cavity and another were determined to have cause an iatrogenic pneumo. So, who knows how many were actually tension pneumos.
--

J Ultrasound Med. 2010 Sep;29(9):1285-9.
Inadequate needle thoracostomy rate in the prehospital setting for presumed pneumothorax: an ultrasound study.
Blaivas M.

57 NT over a 3 year period - 15 found to not be pneumos.

 

[Summit]

I've only seen two in the field. Here are some studies on aeromedical and aeromedical v ground EMS.

http://www.ncbi.nlm.nih.gov/pubmed/20507791

http://www.ncbi.nlm.nih.gov/pubmed/7775785

 

[phideux]

I'm coming up on almost 7000 transports/patients, I've had 1. It was from a stabbing, used a 3" 14ga, patient didn't make it, but at first it seemed to be resolving the pneumo.

 

[triemal04]

And you ain't never going to see one unless you are providing PPV)

Uhmmm....what?

But yeah, pretty uncommon.

 

[DrankTheKoolaid]

In 4 years i have decompressed 5 and had an intern decompress 1. All closed blunt trauma. Never seen one from PPV, but im also very direct and vocal to whoever is bagging to alert me to changes early with any resistance. And with vented patients we use Ardsnet protocol and have yet to have an issue.