Field Tx of Pneumothorax

Data out of LAC showed up to 40% of field placed needles didn't penetrate the chest wall. Make sure the needle gets in, especially on these barrel chested freedom fighter types! :)
 
DoctorDoom said:
Data out of LAC showed up to 40% of field placed needles didn't penetrate the chest wall. Make sure the needle gets in, especially on these barrel chested freedom fighter types! :)
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Listen for the woosh is what I was taught. If you get that you should definently be in the chest cavity
 
surgicalcric said:
Using the appropriate length catheter (3.25") and proper placement 2nd ICS MCL or 5th ICS MAL is the key here.

Good luck hearing that "whooosh" if you are working anywhere other than a controlled setting... ;)

Crip
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Second on that Crip. I did one a few months back and I heard no woosh. Pt. was still in the wrecked car. I did get better pulses and color back with a slight inprovement in mentation though. Looking for signs of improving v/s. are better that wishing for the woosh. I was able to convince the supply guru @ the squad to buy longer needles for that purpose. People think I am a crazy military medic until the rescearch comes out. Go figure. Civilians.

F.M.
 
Are there any studies on these occlusive dressings. Civilian EMS protocols for PA EMT-B is tape three sides and get ALS intercept. TCCC is four sides (or other occlusive) and needle decompression. 18-D do have the option of a chest tube in austure conditions. Is it just limits on scope of practice?
 
cback0220 said:
I am currently carrying HALO chest seals and I think they are the bees knees, link is here: http://www.itstactical.com/medcom/medical/halo-chest-seal/

I think it is the best thing currently out there, it is sticky as shit, which comes in handy when dudes are sweaty/bloody. Then of course the proper utilization of a needle D, and you are gravy ;-)
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Have to concur with the HALO they do stick to anything and do work well. The ACS where a great idea but ive never been able to get them to stick or stay in place with blood and sweat...ever. One more tip so i can feel like im smart. A quick way to find your landmark for a needle D is to put your hand in the pt's armpit (the same way you did when you were a kid making fart noises in school with your hand...lol...thats the best way i can describe it without a picture) and your thumb should line up pretty damn close to mid clavicular 2IC. Works well with big chested guys when its hard to palpate.
 
txpj007 said:
Have to concur with the HALO they do stick to anything and do work well. The ACS where a great idea but ive never been able to get them to stick or stay in place with blood and sweat...ever. One more tip so i can feel like im smart. A quick way to find your landmark for a needle D is to put your hand in the pt's armpit (the same way you did when you were a kid making fart noises in school with your hand...lol...thats the best way i can describe it without a picture) and your thumb should line up pretty damn close to mid clavicular 2IC. Works well with big chested guys when its hard to palpate.
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Holy mackrel! Thats great. I teach P.H.T.L.S. / I.T.L.S. and am going to use this Where did you learn that from?

F.M.
 
Third on props for the HALOs, we tested them after a 2km BCD on the sweatiest hairiest guy known to man and it stuck like shit to a blanket. He was not impressed when we took it off though. Before that we used to carry duct tape to use on the perimeter of the ACS.

I was taught to put a syringe on the end of the catheter (3 1/4") and to watch it rise when you hit the right spot then remove it as we wouldn't hear the air escape. Anyone else doing that or am I being taught dodgy shit?
 
Im gonna co-sign on some stuff here- if you dont have any experience with the HALO, you are using an inferior product. No kidding, that is the best chest seal on the market, hands down. Sticky stuff as good as hydrogel, and its a bitch to take off- youll wax a dude. Only in an extremely manly way, of course.

The landmark for the mid axillary intercostal (4th) space underneath the armpit is money for a couple reasons- 1, your kit doesnt cover there, and you can get to it quickly without removing gear (specifically for the example of TX in a less than friendly environment where removing a chest rig is less than ideal), 2- it's very, very simple. So simple I taught every one of my Rangers that specific technique- and that is NOT a dig on Rangers, I'm using them as an example of "not very medically trained dudes doing a somewhat advanced med procedure". 3- You avoid the ole "what if im too medial and puncture the pericardium and/or heart?" debate. IMO, thats some nonsense, but yea.

Other points- you arent going to hear a whoosh. Seriously. the number one indication of correct placement and relief of a PTHX is patient presentation, specifically O2 sat and patient relief. Crip/DOC/smarter med dudes, correct me if I am wrong. and the 3.5in 14G catheter is my standard for needle D- and hub that mother effer. Seriously, put it to the hilt. With correct placement you will do nothing wrong.

I would like to disagree with the chest tube- we (PJ's) are trained, I have performed them on live patients, they have their place- but not in the field. Life or death, sitting on a pt. for hours at a time with no hope of higher care? i would STILL shy away from this procedure. The risk of infection post event, complexity of the actual procedure, and ability of operator to sedate/administer pain meds adequate to make it happen for the operator are all considerations that should be taken very, very seriously. Also, MOI is most certainly an indication for a "diagnostic" needle decompression. PT complains of shortness of breath and the MOI is indicitave of CX trauma to include blast/percussion- dart em up kid.

Thats just me. Re-attacks?
 
amlove21 said:
Im gonna co-sign on some stuff here- if you dont have any experience with the HALO, you are using an inferior product. No kidding, that is the best chest seal on the market, hands down. Sticky stuff as good as hydrogel, and its a bitch to take off- youll wax a dude. Only in an extremely manly way, of course.

The landmark for the mid axillary intercostal (4th) space underneath the armpit is money for a couple reasons- 1, your kit doesnt cover there, and you can get to it quickly without removing gear (specifically for the example of TX in a less than friendly environment where removing a chest rig is less than ideal), 2- it's very, very simple. So simple I taught every one of my Rangers that specific technique- and that is NOT a dig on Rangers, I'm using them as an example of "not very medically trained dudes doing a somewhat advanced med procedure". 3- You avoid the ole "what if im too medial and puncture the pericardium and/or heart?" debate. IMO, thats some nonsense, but yea.

Other points- you arent going to hear a whoosh. Seriously. the number one indication of correct placement and relief of a PTHX is patient presentation, specifically O2 sat and patient relief. Crip/DOC/smarter med dudes, correct me if I am wrong. and the 3.5in 14G catheter is my standard for needle D- and hub that mother effer. Seriously, put it to the hilt. With correct placement you will do nothing wrong.

I would like to disagree with the chest tube- we (PJ's) are trained, I have performed them on live patients, they have their place- but not in the field. Life or death, sitting on a pt. for hours at a time with no hope of higher care? i would STILL shy away from this procedure. The risk of infection post event, complexity of the actual procedure, and ability of operator to sedate/administer pain meds adequate to make it happen for the operator are all considerations that should be taken very, very seriously. Also, MOI is most certainly an indication for a "diagnostic" needle decompression. PT complains of shortness of breath and the MOI is indicitave of CX trauma to include blast/percussion- dart em up kid.

Thats just me. Re-attacks?
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No re-attacks here bro...you're spot on. I'm really gonna have to start posting when I have time to spell it all out as well you and not between smoke sessions with my quick to the point mildly sarcastic manner.
 
txpj007 said:
No re-attacks here bro...you're spot on. I'm really gonna have to start posting when I have time to spell it all out as well you and not between smoke sessions with my quick to the point mildly sarcastic manner.
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The whole woosh thing was a sarcastic post, it was one of my first posts here before I had learned the sarcasm of the internet. I don't want to come across as if I was saying that as a real diagnostic tool.
 
txpj007 said:
Have to concur with the HALO they do stick to anything and do work well. The ACS where a great idea but ive never been able to get them to stick or stay in place with blood and sweat...ever. One more tip so i can feel like im smart. A quick way to find your landmark for a needle D is to put your hand in the pt's armpit (the same way you did when you were a kid making fart noises in school with your hand...lol...thats the best way i can describe it without a picture) and your thumb should line up pretty damn close to mid clavicular 2IC. Works well with big chested guys when its hard to palpate.
Click to expand...

I have no Idea what a HALO is. The Hyfin is (was) the standard (at my level) the last I heard, The ACS was declared a no go a couple of years ago due to it not sticking to blood etc...

The alternate site (not mid clavicular) for a NCD is lateral under the arm pit, four fingers down from the arm pit, small word lol.

Wooshing etc... aside, would the Pt's breathing/comfort level be an immediate indicator of successful needle placement?
 
pardus said:
...The alternate site (not mid clavicular) for a NCD is lateral under the arm pit, four fingers down from the arm pit, small word lol.
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Mid/Anterior Axillary line is the word(s) you are are looking for in that description.

HALOs are good seals as are Bolins but I am a Hyfin fan myself... The Asherman still sucks ass even with new glue; stay away from them. In fact guys would do better to use 100mph tape and the ACS packaging for an occlusive dressing...

Crip
 
surgicalcric said:
Mid/Anterior Axillary line is the word(s) you are are looking for in that description.

HALOs are good seals as are Bolins but I am a Hyfin fan myself... The Asherman still sucks ass even with new glue; stay away from them. In fact guys would do better to use 100mph tape and the ACS packaging for an occlusive dressing...

Crip
Click to expand...

Thanks mate, I had a brain fart on that one.
 

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