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Wed Sep 17 18:33:53 BST 2008

Hay list

The TCCC say the needle must bee 3.25 inch and 14-gauge,  2 1/2 inch as dr
Mcswain says, it is not a new thing, know 3-4 studies don, whit US and CT,
that all say the same thing, normal IV needle is to short.

EMJ had a good paper on tension PTX, a while back, take a look at that one.
It was call "Tension pneumothorax—time for a re-think?" by S Leigh-Smith and
T Harris. Send me at mail if you like I have it.

Frank Hansen

-----Oprindelig meddelelse-----
Fra: McSwain, Norman E Jr. [mailto:nmcswai at tulane.edu] 
Sendt: 16. september 2008 15:41
Til: Trauma &amp; Critical Care mailing list
Emne: RE: Needle Decompression

If you are really in the chest then it should be left in place. However
there is some good data from the Tactical Combat Casualty Care committee
that many needles are NOT long enough to penetrate into the chest
cavity. This is from some recent cadaver studies looking at the actual
anatomy and length of the needles used. The new standard for the
military developed by TCCC is that a 2 1/2 inch needle should be used to
successfully accomplish decompression. The usual needle for IV access
needle is 1 1/2 inches or shorter. 

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 Sahaj Khalsa
Sent: Monday, September 15, 2008 11:48 PM
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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