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Tue Sep 16 21:02:34 BST 2008

Thanks for everybody's responses, it is interesting to see all of the
differences of opinion that exist.  I would like to clarify a few points:
1. The site for needle decompression is not always the anterior chest.  It
is also well accepted to decompress the chest at the mid-axillary site.  It
seems that blood from this site is more common.
2.  The standard catheter that we use is a 14 ga 2.5 inch.
3.  Percussion is unreliable (at best) in the prehospital environment, it is
just too noisy for it to be a reliable indicator of anything.  The major
Paramedic texts recognize this and now only briefly mention percussion.
4.  It seems to me that if I am waiting for the "classic" signs of Tracheal
deviation, hypotension and JVD, I am well behind the curve, right?
5.  I fully understand that needle decompression is not something that
should be done commonly, and have done it very infrequently.  However, when
I have done it, I have seen marked improvement in my patients.

I will look up the papers and articles that some of you have provided to
hopefully shed some more light on the subject.

Thanks again,

Sahaj Khalsa

On Tue, Sep 16, 2008 at 1:11 PM, Robert Waddell II
<bobwaddell at bresnan.net>wrote:

> Thanks Tim, I'll try to get the paper.  Your comments have a greater volume
> than some may see in that the classic signs, especially those listed in most
> of the text, include deviated trachea.  I believe it was Lee in the 80's who
> showed through a large post evaluation analysis that tracheal deviation
> occurred in non-viable (dead) patients and was an extremely late sign and
> demonstrated that looking for the deviation wasted time and aided in the
> practitioner loosing focus of the treatable injuries.  Maybe it is time for
> main stream EMS to re-think the "why we do what we do" and get back to a
> stronger focus on the patient we're caring for and their positive outcomes.
>  Thanks again.
>
> Take care,
>
> Bob
> bobwaddell at bresnan.net
> 307 920 2020
>
>
> On Sep 16, 2008, at 12:53 PM, Coats Tim - Professor of Emergency Medicine
> wrote:
>
>
>> Several posts on this thread have mentioned the 'classic' signs of tension
>> pneumothorax. However there is a very good paper from the Emergency Medicine
>> Journal in 2005 that should make you rethink and question. See:
>>
>> Leigh-Smith S, Harris T. Tension pneumothorax—time for a rethink?
>> EMJ 2005;22:8–16.
>>
>> What SImon and Tim showed was that 'classic' signs of tension pneumothorax
>> are based on operative experience in an anaesthetised patient, where
>> compensatory mechanisms have been reduced. In the non-anaesthetised patient
>> there may be a number of compensatory mechanisms which means that the
>> 'classic' signs may well not be present. My experience is that in a
>> non-anaesthetised patient the 'classic' signs of tension pneumothorax only
>> occur periarrest.
>>
>> On the issue of 'does field needle thorocostomy work?' my experience is
>> yes, but only very occasionally. It is certainly not as important an
>> intervention as some prehospital trauma courses make out.
>>
>> Tim Coats.
>> Professor of Emergency Medicine.
>> Leicester University, UK.
>>
>>
>>
>> -----Original Message-----
>> From: McSwain, Norman E Jr. [mailto:nmcswai at tulane.edu]
>> Sent: Tue 9/16/2008 4:14 PM
>> To: Trauma &amp; Critical Care mailing list
>> Subject: RE: Needle Decompression
>>
>> See my comments from the two previous postings this morning. I would
>> only add that I have used it several times in the field myself with
>> apparent success. I say apparent because there were no radiographs to
>> prove a anatomical pathophysiological improvement. General improvement
>> in the patient's condition that made me believe that something had been
>> accomplished by it
>>
>> Norman
>>
>> Norman McSwain Jr, MD FACS
>> Trauma Director Charity Hospital
>> Professor of Surgery
>> Tulane University School of Medicine
>> 504 988 5111
>>
>>
>> -----Original Message-----
>> From: trauma-list-bounces at trauma.org
>> [mailto:trauma-list-bounces at trauma.org] On Behalf Of kmattox at aol.com
>> Sent: Tuesday, September 16, 2008 9:23 AM
>> To: Trauma &amp; Critical Care mailing list
>> Subject: Re: Needle Decompression
>>
>> I for one have never been impressed, nor seen real benefit from needle
>> decompression of the chest.
>>
>> K
>>
>>
>>
>> ------Original Message------
>> From: Dr Ross Hofmeyr
>> Sender: trauma-list-bounces at trauma.org
>> To: 'Trauma &amp; Critical Care mailing list'
>> ReplyTo: Trauma &amp; Critical Care mailing list
>> Sent: Sep 16, 2008 9:04 AM
>> Subject: RE: Needle Decompression
>>
>>  You put
>>> in in for proper indications ( decreased breath sounds,
>>> decreased oxygenation) then is doing its job allowing the
>>> lung to expand (blood or air they both can compress the
>>> lung).
>>>
>>
>> *Screeches to halt*
>>
>> Holdonamminit - how, pray tell, does a cannula in the chest help the
>> lung
>> expand?  Do you mean a cannula PLUS non-return valve of some form?
>>
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