needle thoracostomy

[triemal04]

Right. So you just did a procedure that didn't fix the initial problem, and in fact, created more. That could probably be seen as a drawback to most people. Does it mean don't use longer catheters? Absolutely not. Does it mean that you have something else to be aware of? Yep.

While a small puncture may seal itself, you have still caused further damage, bleeding, increased the chance of infection et al. And while a laceration is rare (puncture is as well) it will not seal itself as quick, and lead to more bleeding, etc etc. Sounds like a drawback to me.

 

[AJ Hidell]

If it were harmless, it would be a basic skill.

 

[triemal04]

If it were harmless, it would be a basic skill.

:censored::censored::censored::censored:, I'm surprised it's not; intubation has 10 times the number of associated problems, and in some places it's a basic skill. :wacko:

Everything we do has pluses AND minuses, and many things will cause more damage, or have the potential to. Doesn't mean that we should stop doing them, just that we should be aware of it.

 

[Ridryder911]

The problem I have had is simple angiocaths occlude. Yeah, I have brought patients in that looked like a porcupine.

With commercialized kits, most have a nice large enough lumen and as well silicone inside that prevents kinkage and occulussion.

R/r 911

 

[medic417]

Everything we do has pluses AND minuses, and many things will cause more damage, or have the potential to. Doesn't mean that we should stop doing them, just that we should be aware of it.

Very good point. Sadly many ignore the possible bad effects and so do not prepare for the possibilty. Nor will they do what is needed to limit the possibility of the bad effect.

 

[Ridryder911]

:censored::censored::censored::censored:, I'm surprised it's not; intubation has 10 times the number of associated problems, and in some places it's a basic skill. :wacko:

Everything we do has pluses AND minuses, and many things will cause more damage, or have the potential to. Doesn't mean that we should stop doing them, just that we should be aware of it.

The problem is lung sounds are not technically a basic skill. So, recognizing a down lung is obvious a problem. In my state even an advanced or Intermediate are not allowed to decompress.

R/r 911

 

[zzyzx]

So if you guys could choose between using a 10, 12, and 14 gauge needle to decompress, which would you use?

 

[medic417]

http://www.narescue.com/Needle-Decompression-Kit-P18C2.aspx

 

[triemal04]

The problem is lung sounds are not technically a basic skill. So, recognizing a down lung is obvious a problem. In my state even an advanced or Intermediate are not allowed to decompress.

R/r 911

As well they shouldn't, believe me, I'm not argueing for that. But...just to get people yelling...for the states that allow basics to intubate...guess they should allow decompression; after all the basic must be proficient enough at lung sounds to be able to determine if the tube has slipped into the right/left bronchi...

Edit: At least 12. They are longer which leads to better success rates, and the incidences of further damaging the lung are pretty rare. Plus the lumen is larger which keeps it from clotting over for longer and allows more air out rapidly...though that's a little relative.

 

[TransportJockey]

I've only ever seen 14g used to decompression, but we've used the 3" caths in class. I start internship in 3 weeks and can report back then, but even the IFT company I worked for only had 14s as teh biggest we carried. I've never seen 12 or 10

 

[Tal]

We use 14's here.

Same here.
funny thing is, we sometimes use the infants chest drian vygon needle as a NA, but puncture the skin with scalple before penetrating.

 

[maxwell]

I've never had a problem. I have plenty of pts c ptx's and I use a #14 angio and get the fabulous (the real meaning of the words, root: fable) "woooosh" while the patients SaO2 comes up (FTW!). I've heard this argument before - and I don't have much data that supports it. Size (of the needle folks, come on, stay with me) here doesn't matter as long as its a standard angio. Pediatrics...way different. For neonates, I've seen butterflies used with good results. For kids, #20s work okay.

Remember, the worst thing about popping the chest with a needle is that you could hit lung (provided you dont go inferior to the superior rib and hit the VAN bundle...:deadhorse. And hell, they're getting a chest tube anyway.

 

[boingo]

Ummm...No, the worst thing that could happen is you could use an inappropriate sized catheter that never enters the pleural space, thus not decompressing the tension and the pt goes on to die. Size DOES matter. Don't kid yourself. A 2" catheter is inadequate for most adult males with moderate muscle development, incidently the same demographic of pts I tend to see with these injuries.

 

[maxwell]

Ummm...No, the worst thing that could happen is you could use an inappropriate sized catheter that never enters the pleural space, thus not decompressing the tension and the pt goes on to die. Size DOES matter. Don't kid yourself. A 2" catheter is inadequate for most adult males with moderate muscle development, incidently the same demographic of pts I tend to see with these injuries.

When I said "the worst thing" I meant the worst complication. This is assuming you know what you're doing i.e. you know when you've decompressed it. Moderate muscle development? What? You don't have fat gangsters?! Let us not forget the tall, lanky, skinny dudes with spontaneous ptxs (had one yesterday!). I used a 1.25" angio and worked just fine!

 

[boingo]

http://www.anesthesia-analgesia.org/cgi/content/full/105/5/1385

Fat gangsters need even a longer catheter. Insert a large-bore (ie, 14-gauge or 16-gauge) needle with a catheter into the second intercostal space, just superior to the third rib at the midclavicular line, 1-2 cm from the sternal edge (ie, to avoid injury to the internal thoracic artery). Use a 3-6 cm long needle, and hold it perpendicular to the chest wall when inserting; however, note that some patients may have a chest wall thickness greater than 3 cm and failure for the symptoms to resolve may be attributed to inadequate

http://www.jtrauma.com/pt/re/jtraum...9f86bBh212QcL4h!-1046349743!181195628!8091!-1

 

[Ridryder911]

Also the lumen size should be emphasized. It has been well known most 14g cath occlude off. If a service performs these type of procedures often enough then they should invest in a commercialized kit.

R/r 911

 

[rhan101277]

http://www.anesthesia-analgesia.org/cgi/content/full/105/5/1385

Fat gangsters need even a longer catheter. Insert a large-bore (ie, 14-gauge or 16-gauge) needle with a catheter into the second intercostal space, just superior to the third rib at the midclavicular line, 1-2 cm from the sternal edge (ie, to avoid injury to the internal thoracic artery). Use a 3-6 cm long needle, and hold it perpendicular to the chest wall when inserting; however, note that some patients may have a chest wall thickness greater than 3 cm and failure for the symptoms to resolve may be attributed to inadequate

http://www.jtrauma.com/pt/re/jtraum...9f86bBh212QcL4h!-1046349743!181195628!8091!-1

LOL fat gangsters

 

[rhan101277]

:deadhorse:

 

[VentMedic]

:deadhorse:

You mean you did not learn anything from this thread? The differences presented here makes this a worthwhile topic. Granted EMT-Bs may not understand this now but some day you may want to advance.

 

[reaper]

How can you say it is beating a dead horse, if you have never done it? This is a good argument.

Most services use a 14ga 3-3.5" long. I would love for my service to go to 10's or 12's. 14's do clog off and then you have to put another one in.