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Tue Sep 16 13:36:02 BST 2008

Sahaj, welcome to the inside of the worm can...

My overall opinion is similar to Pret - if you're getting blood back it is
either from the lung (in which case you've just caused a nasty problem),
from the pleural cavity (in which case you have far bigger problems) or from
a vessel (in which case, you've caused ANOTHER problem).  In the case of the
first or third situation, I'd rather pull it out.  In the second case, it is
going to be draining pretty slowly and will likely clot up anyway, so pull
it out.  I remain unconvinced that a 'tension hemothorax' can exist.

Needle decompression remains a thorn in the side of many trauma doctors (pun
intended), because it is used FAR more often than indicated.  You need to be
VERY clear on the indications for performing a decompression in the first
place - hypotension and decreased breath sounds are NOT the indications, as
suggested to me several times in the past by both pre-hospital personnel and
doctors attending ATLS tuts...

R.

Dr Ross Hofmeyr
Expedition Leader  & Doctor
South African National Antarctic Expedition
ross.hofmeyr at sanae.sanap.ac.za
wildmedic at gmail.com
ross at wildmedix.com
www.wildmedix.com
Tel: +2721 405 9428
Skype:  wildmedic
"Semper Paratus"

> -----Original Message-----
> From: trauma-list-bounces at trauma.org 
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Sahaj Khalsa
> Sent: 16 September 2008 04:48 AM
> To: Trauma &amp, Critical Care mailing list
> Subject: Needle Decompression
> 
> Hello all,
> 
> Many thanks to all of those who have been keeping all of us 
> updated about their situations during this horrible hurricane 
> season.  I have lots of family in Houston so I felt like I 
> had a more real and direct line to what was going on than the 
> news, which was great.  Our thoughts and prayers are with all 
> of you who are still recovering from all of the devastation.
> 
> So I am interested in the opinions of anybody on this list 
> who cares to share them and has a few spare minutes...
> 
> I am a Paramedic and a paramedic instructor and we are 
> trained that when we decompress a chest (usually with a 14 ga 
> catheter) and get blood flow back, we should pull the catheter.  Why?
> 
> I have discussed this with a number of the ER docs that I 
> work with and there is no real clear consensus.  Some of them 
> say that I should leave the catheter in the chest as 
> relieving the pressure is a good thing, whether that pressure 
> is caused by blood or air.  However, most Paramedic textbooks 
> advise us to pull it.
> 
> Assuming that I have put the dart in correctly (and have not 
> hit the vessels in the chest wall), understanding that I do 
> not have the capability of putting in a chest tube and that I 
> am often times more than 60 minutes by ground from the 
> nearest hospital with no alternative transport (helo) 
> available, what is your opinion?
> 
> Any replies would be appreciated.
> 
> Sahaj Khalsa
> --
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