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Fri Sep 19 22:58:26 BST 2008

It really doesn't matter. You aren't going to get enough blood up a 14 gauge
to make any difference to a massive haemothorax. You may be fooled, anyway.
Splatters of blood often come up after the air in a successful
decompression. Leave it unless it falls out and then just increase your
observation rate.

Tension pneumothoraces are interesting creatures. You know how you aren't
supposed ever to have a CXR of one? Well, I have several in my collection,
and they all have one interesting common feature - the lung is NOT
collapsed. A spontaneous pneumothorax often looks like a fist at the hilum
surrounded by space. Not so a tension - the chest is distended with gross
mediastinal shift, but the lung is there - just an edge visible maybe an
inch from the parietal pleura. The effects are from the haemodynamic
consequences of raised intrathoracic pressure and the symptoms from the
respiratory embarrassment. The last one I relieved was in a man trapped in a
Volvo who had clipped a truck on a dual carriageway (freeway US) and had
been flipped over the barrier to sustain an impact from an oncoming Jaguar
into the front passenger door. What with the fire team cutting gear and the
helicopter landing next to me hearing the hiss of air was difficult, but the
improvement in his condition was most gratifying. 

Best Wishes,

Rowley. 
-----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 05:48
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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Needle Decompression