Needle Decompression

[michael150]

Hey guys....

There seems to be a huge argument between some doctors and paramedics in my area. The docs seem to all agree that when medics do a needle decompression, if there is blood return, it is assumed to be a tension hemo-pneumothorax we DO NOT pull the catheter. However, in medic, we are being taught to pull it and then control the hemorrhage. What do you think? What's the standard of care where you are?

 

[DesertMedic66]

Insert the needle and if blood comes out we can either pull it out or cap it.

 

[VFlutter]

The question comes down to if you successfully cannulated the plural space and they truly have a tension hemo-pnuemo or if you inadvertently hit vasculature. Is blood bubbling out with respiration or is a continuous stream of blood.

 

[michael150]

The question comes down to if you successfully cannulated the plural space and they truly have a tension hemo-pnuemo or if you inadvertently hit vasculature. Is blood bubbling out with respiration or is a continuous stream of blood.

Chase, the question is if we correctly cannulated the pleural space and blood is returned, what do we do?

 

[VFlutter]

Chase, the question is if we correctly cannulated the pleural space and blood is returned, what do we do?

This has been discussed on here before. I think the debated consensus is that it's probably not a great idea to drain a hemothorax in the field without availability of blood products. Not that a 14g catheter is going to quickly do so. You could cap it unless the patient is hemodynamically unstable. But that is something that your medical control and local trauma surgeons should probably be in agreement with.

 

[Colt45]

I see where your docs are coming from. A buddy of mine was running a code and had all the signs of pnuemo as well so they did a needle decompression and initially got an audible rush of air.. and then during each compression blood was squirting through the catheter. It was basically a last ditch effort and the MD realized that so he was ordered to leave it in to relieve some of the pressure on the heart and increase some circulation. I was told to cap them in my class as well but I guess it just depends on the situation.