the 100% directionless thread

[VentMonkey]

At least I haven’t done any liver biopsies with a 3.25” 14G ARS needle.

Ouch. Also, that makes 5,000 for me haha.

 

[DragonClaw]

At least I haven’t done any liver biopsies with a 3.25” 14G ARS needle.

Low hanging fruit indeed.

What's wrong with the liver thing?

 

[DesertMedic66]

Oh is the epi they use for arrests (IV) racemic or is that something else?

Different

What's wrong with the liver thing?

The paramedic was attempting to decompress the chest however went way too low and instead went into the liver and still put in the documentation that he “heard the rush of air”. We don’t stick anything into the liver in the EMS setting.

 

[DragonClaw]

Different

The paramedic was attempting to decompress the chest however went way too low and instead went into the liver and still put in the documentation that he “heard the rush of air”. We don’t stick anything into the liver in the EMS setting.

Ah.

Yeah I wasn't familiar with any liver procedure. But if there's like a liver evisceration or something maybe take it with us or something. But yeah, I'm not sure how you compress that far inferior to the sternum to do that.

Is it true that you shouldn't even break the xyphoid process with good CPR? I've heard it both ways on that one.

I would lean towards that it shouldn't be if you're properly positioned. Maybe break the manubrium from the body though.

Edit: Wait did you mean a needle decompression into the lung? Either way...

 

[DesertMedic66]

Ah.

Yeah I wasn't familiar with any liver procedure. But if there's like a liver evisceration or something maybe take it with us or something. But yeah, I'm not sure how you compress that far inferior to the sternum to do that.

Is it true that you shouldn't even break the xyphoid process with good CPR? I've heard it both ways on that one.

I would lean towards that it shouldn't be if you're properly positioned. Maybe break the manubrium from the body though.

Not decompress the chest for CPR. The medic was attempting to do a needle thoracostomy to decompress a tension pneumothorax. The medic attempted to do it using one of the county’s approved sites (right mid-axillary at the 4th or 5th ICS). However the medic did not realize how the ribs and intercostal spaces are positioned laterally. So we went way too low and hit the liver. The majority of the liver is protected by the rib cage

 

[DragonClaw]

Not decompress the chest for CPR. The medic was attempting to do a needle thoracostomy to decompress a tension pneumothorax. The medic attempted to do it using one of the county’s approved sites (right mid-axillary at the 4th or 5th ICS). However the medic did not realize how the ribs and intercostal spaces are positioned laterally. So we went way too low and hit the liver. The majority of the liver is protected by the rib cage

I just realized that is what you meant.

But yeah that's an ouch and a rush of air..

Maybe from the diaphragm... but a solid organ like the liver...

L a w s u i t

 

[CALEMT]

You’ll never hear a rush of air.

 

[DragonClaw]

You’ll never hear a rush of air.

Ever ever?

 

[VentMonkey]

You’ll never hear a rush of air.

Never say never, you’ll hear it and immediately notice that their trachea has returned to midline. Just like a blind stick of pericarial Epi a la Vince Vega. Or that scene in Three Kings (still a cool visual IMO), either way...

In all seriousness, tracheal deviation is apparently more noticeable on CXR, hence the “late sign” touted in paramedic school.

I’d highly recommend a boot camp CXR class like the TPATC course for all paramedics.

 

[DesertMedic66]

Ever ever?

If you are in somewhat of a quite environment then you probably will hear it. If you are on the side of a freeway then probably not.

 

[StCEMT]

I've always attached my 14g's to a partially filled flush for a visual indicator. Between patients yelling or just the general noise of an ambulance, I don't think I've ever been somewhere quiet enough that I'd even try to hear.

 

[DragonClaw]

I've always attached my 14g's to a partially filled flush for a visual indicator. Between patients yelling or just the general noise of an ambulance, I don't think I've ever been somewhere quiet enough that I'd even try to hear.

Looking for an air bubble?

 

[StCEMT]

Looking for an air bubble?

Yep. If you draw the flush back and you're still in tissue, it's not gonna move because it is like the flush is capped. Break through to the pleural space and you'll see bubbles as well as the release of that resistance. It also just provides a big *** handle, which I definitely prefer. One of the ones I did last year was while transporting a GSW and I don't have smooth county roads, so I find the added surface area to grip helpful.

 

[StCEMT]

Side note, have any of y'all ever actually seen tracheal deviation not on a scan? I've seen plenty on a CXR, but that's further down. Even the extreme ones on CXR seem to be fairly midline by the time you get to the neck.

 

[NomadicMedic]

I usually wind up popping trauma arrests. I've only decompressed 2 live people. No trach deviation or hisssssssss on either.

 

[CALEMT]

Home for the next couple days

 

[DragonClaw]

View attachment 4983

Home for the next couple days

PINE TREES!!

 

[NomadicMedic]

We're putting our camper at a seasonal spot in 2 weeks. We can stay by ourselves just as well at a campground.

 

[DragonClaw]

New favorite hospital mural

https://imgur.com/a/WiA5LEp

 

[ffemt8978]

Side note, have any of y'all ever actually seen tracheal deviation not on a scan? I've seen plenty on a CXR, but that's further down. Even the extreme ones on CXR seem to be fairly midline by the time you get to the neck.

Once on what eventually turned into a fatality accident. It wasn't blatently obvious but was noticeable if you looked for it.