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Tue Sep 16 15:30:38 BST 2008

Sahaj, 

  I have to tell you about a call I had done a few years ago.  We received a call for a woman who fell over 30 feet off a porch and onto her back.  On a grassy area.  Her LOC was diminished, her skin was mottled and had a very thready radial pulse, to boot she was on long term benzo use and had a Hx of chronic etoh use.  Both choppers were grounded in the area to do Wx.  About 8 minuets was spent on scene and we transported To Beth Israel Boston.  Enroute we made and attempt to intubate.  The only medications we have onboard are Versed, MSO4, Valium and Ativan.  Along with medical consult we received orders for use of the meds.  Obviously they didn't work to sedate enough.  So we elected to continue assisting her vents with BLS maneuvers.   About 6 min into the ride she developed hypotension, absent L.S on her left side and JVD.  Her SP02 was 89 via BVM.  We knew we were dealing with massive Cx injuries and made the decision that she needed to be decompressed.  
  The area was prepped, and we used a 14 ga over the hub needle.  A huge outlet of air was heard.  Immediately after, her SP02 increased, her BP returned to her B/L and things were looking up.  Almost as soon as we put the needle in her there was a small amount of aerated blood that had come out of the needle.  She remained stable for the next 7 min till it took us to get to the ED.  I had stayed enough to watch her get paralyzed and tubed.  At the same time she got 2 chest tubes draining huge amounts of blood.  
  I did a follow up later on with the trauma surgon and besides multiple ortho injuries she had a double hemo PTX.  So for this case the blood was from her cx injury we suspected. I'm sure others will disagree and maybe the more educated might be able to shed light as to why it presented like that.  

Anthony Caruso. NREMT-P> Date: Mon, 15 Sep 2008 22:47:34 -0600> From: sahajs at gmail.com> To: trauma-list at trauma.org> 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> --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/
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