Chest decompression

U

ukparamedic

Longterm Registered User
Does anyone have real life experience of doing a needle thoracocentesis (Chest decompression?)

I did my first 'real' one last night and was surprised at how much force was needed to get the needle in compared to the mannequin and also at how fast and loud the rush of air was. There was also quite a bit of blood which doesn't happen on the mannequin!
 
Not being cheeky like, but we're you not told of all that when training?

I remember practising it on the dummy and the MO instructing us giving us the full gory truth right down to how hard it can be pushing through the intercostal...

What was your casualties condition (aside a TP?) & mechanism, out of curiosity?
 
Being told something and experiencing it are two entirely different things.

I can't reveal anything about the incident due to confidentiality other than it was a fall from a great height onto concrete, GCS 7.
 
Your very right you dont expect to apply that much pressure,i ve done two both very different and p/t outcome increased but not for long,the bigger bore the better.All set for the next one good luck!!
 
Nice one UKparamedic

It takes knowledge and balls in the pre-hospital

I hope the A/E appreciated the expertise and courage needed to do such an invasive procedure

Good to have you on the forum

NN
 
A&E were happy because when they put the drain in, while there was still some air in the chest; most of it had been released by the needle. I have done some research since the incident and found that a needle thoracocentesis is as effective as a chest drain for up to 4 hours. As my patients are in my care less than 4 hours, this is a promising piece of research.
 
Barton ED, Epperson M, Hoyt DB, Fortlage D, Rosen P. Prehospital needle aspiration and tube thoracostomy in trauma victims: a six-year experience with aeromedical crews. J Emerg Med. 1995;13:155–163
 
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You might also be interested to know that tension pneumothorax is responsible for the deaths of approximately 4% of fatal combat casualties. 20% of fatal casualties have a tension pneumothorax but 4% of deaths are caused directly by the tension pneumothorax. Only 1.5% of all the casualties with a tension pneumothorax actually live long enough to be treated by a medic.

The solution? Give all soldiers and frontline troops the training to recognise and treat tension pneumothorax. A 14G 3.25" cannula costs 12p! 12p that will save the lives of 4% of our troops who would otherwise be dead.
 
When I did my Police Medics course and later my FAAW with BLS LTd we were told that it is better to break a couple of ribs especially in older people and save their life that do pathetic shallow compressions. I did chest compressions on a collapsed rugby player in 2006 at a cup game in South Wales prior to administering AED. Nothing appeared to bring him back, the RRV arrived and used a Lucas the piston pushes the chest to the spine!!! it looks very brutal. It's fine on a 18 stone rugby player but on a frail pensioner it's uncomfortable to watch.
 
Hands up, that will teach me to read the thread thoroughly ouch!!! As for the ribs that's what we were told, there were trainers from the ambulance service in attendance. Apologies for the school boy error.
 
Lol did you think it said chest compressions then? Never mind we all make mistakes.

Regarding the broken ribs, this is a very old myth that people still believe. It is far more likely that the crack is an intercostal tendon snapping than a rib breaking.
 
Daz, the $15 is an over priced cleverly marketed scam. A 14 gauge 3.25" cannula can be purchased for approximately 12p. The ARS is highly priced as it comes in a 'special package' and to be honest is a bit of a con. I have had a look at the link and it is interesting that they quote the same reference I have quoted above. I can buy a 14g 3.25" cannula for 12p wholesale and it's a waste of money paying for the same device in different packaging.

Is it worth the extra cost just because it is in different packaging and doesn't have a flash chamber? I don't think it is. Buy the identical but much cheaper regular cannula and just store it properly and remove the flash chamber like I and every other paramedic does.

I spoke to a company in China (who I currently import products from) and they have offered to package an identical cannula without flash chamber into a similar package (but different enough not to breach trademark/copyright law) for less than $0.02 FOB (2 cents i.e. 1p) each (based on an MOQ of 100,000). The ARS is not CE marked so cannot be used in Europe but the ones I can get would be CE marked.

Or (and as I keep saying) just use a regular 14g 3.25" cannula and store it properly so the packaging isn't damaged!

If every soldier was taught this skill and issued a 12p cannula (or if you want to buy them individually from retailers such as SP £1.80) then 4% of combat deaths would be prevented!
 
ukparamedic said:
Daz, the $15 is an over priced cleverly marketed scam. A 14 gauge 3.25" cannula can be purchased for approximately 12p. The ARS is highly priced as it comes in a 'special package' and to be honest is a bit of a con. I have had a look at the link and it is interesting that they quote the same reference I have quoted above. I can buy a 14g 3.25" cannula for 12p wholesale and it's a waste of money paying for the same device in different packaging.

Is it worth the extra cost just because it is in different packaging and doesn't have a flash chamber? I don't think it is. Buy the identical but much cheaper regular cannula and just store it properly and remove the flash chamber like I and every other paramedic does.

I spoke to a company in China (who I currently import products from) and they have offered to package an identical cannula without flash chamber into a similar package (but different enough not to breach trademark/copyright law) for less than $0.02 FOB (2 cents i.e. 1p) each (based on an MOQ of 100,000). The ARS is not CE marked so cannot be used in Europe but the ones I can get would be CE marked.

Or (and as I keep saying) just use a regular 14g 3.25" cannula and store it properly so the packaging isn't damaged!

If every soldier was taught this skill and issued a 12p cannula (or if you want to buy them individually from retailers such as SP £1.80) then 4% of combat deaths would be prevented!
Click to expand...

I agree with everything you say mate, even a non-medical professional such as myself can see a clever bit of marketing and i have just been discussing the same with a medic here, fortunately USG pays for mine and they are a BIG firm!!

Maybe some of the military medics can jump in here but i assume that british army soldiers are taught NCD at the individual level just as are US soldiers.

Daz
 
I have done thoracocentesis about a dozen times now and it works very well both at the 2nd intercostal mid clavicular site and the 4th intercostal mid axilla space.
 
Good skills mate. It does take guts to push that 14 gauge in. Needle decompression is one of the most dramatic life saving skills we get to perform. Good job your patient wasn't in Perth! Glenno
 
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