Archive for the ‘Breathing’ Category

Chest Decompression for Non-Medics

Thursday, January 28th, 2010

Chest decompression for non-medics is a sticky subject. Recent observations overseas have seen an increase in improper location medially when inserting the needle. The causes of the high rate of improper placement are difficult to determine (i.e., environment, visibility, etc.) and have led to some medical directors prohibiting the procedure for non-medics within the military and LEO teams. However, the below study illustrates that proper initial training leads to high retention rates, thereby making this a skill that ought to remain at the operator level.

Abstract
Introduction: Tension pneumothorax is the second leading cause of preventable combat death. Although relatively simple, the management of tension pneumothorax is considered an advanced life support skill set. The purpose of this study was to assess the ability of non-medical law enforcement personnel to learn this skill set and to determine long-term knowledge and skill retention.

Methods: After completing a pre-intervention questionnaire, a total of 22 tactical team operators completed a 90-minute-long training session in recognition and management of tension pneumothorax. Post-intervention testing was performed immediately post-training, and at one- and six-months post-training.

Results: Initial training resulted in a significant increase in knowledge (pre: 1.3 ±1.35, max score 7; post: 6.8 ±0.62, p < 0.0001). Knowledge retention persisted at one- and six-months post-training, without significant decrement.

Conclusions: Non-medical law enforcement personnel are capable of learning needle decompression, and retain this knowledge without significant deterioration
for at least six months.

Needle DC for Non-Medics

Needle Decompression Hazards

Thursday, August 20th, 2009

Historically, tension pneumothax has been the 2nd leading cause of preventable death on the battlefield. Therefore, this is an important skill and is being taught to medics at the lowest level of care. However, as with all procedures, risks are involved. Feedback from the field has indicated that medics are performing this procedure too often and TOO medial, causing multiple complications.

The above video covers the hazards of a needle decompression. Below you will find a brief review of indications, contra-indications, etc. As always, please follow local protocols.

INDICATIONS:
Needle decompression is indicated for the treatment of:
A. Tension pneumothorax and / or
B. Tension hemopneumothorax

CONTRA-INDICATIONS:
A. Chest decompression is indicated in the field only in the face of a life-threatening
tension pneumothorax. In that situation, there are essentially no contraindications since
the only alternative is almost certain death.

CAUSES OF TENSION PNEUMOTHORAX:
A. Blunt force trauma to the chest that ruptures a portion of lung tissue
B. Fractured rib that punctures the lung tissue
C. Spontaneous pneumothorax for no apparent reason
D. Conversion of a simple pneumothorax to a tension pneumothorax by positive pressure
ventilation as with a bag-valve mask device etc.
E. Open pneumothorax that is covered and left unattended developing into a tension
pneumothorax

SIGNS/SYMPTOMS
A. Chest pain
B. Severe respiratory distress
C. Tachycardia
D. Hypotension
E. Decreased or absent breath sounds on affected side

LATE SIGNS / SYMPTOMS:
A. Cyanosis
B. Distended neck veins
C. Tracheal deviation away from affected side

Pic 3
(Source: Canadian Tactical and Operational Medical Solutions)

COMPLICATIONS:
A. Creation of pneumothorax where none existed previously
B. Laceration of lung tissue
C. Bleeding from laceration of intercostal blood vessels
D. Severe pain to conscious patient (since this is life-threatening, the procedure must be
continued )
E. Local hematoma
F. Laceration and/or puncture of the heart

How long Is Your Needle?

Monday, October 20th, 2008

Chest Wall Thickness in Military Personnel: Implications for Needle Thoracentesis in Tension Pneumothorax

Author(s)
HARCKE H. Theodore ; PEARSE Lisa A. ; LEVY Angela D. ; GETZ John M. ; ROBINSON Stephen R. ;

Journal Title
Military Medicine ISSN 0026-4075

Abstract

Needle thoracentesis is an emergency procedure to relieve tension pneumothorax. Published recommendations suggest use of angiocatheters or needles in the 5-cm range for emergency treatment. Multidetector computed tomography scans from 100 virtual autopsy cases were used to determine chest wall thickness in deployed male military personnel. Measurement was made in the second right intercostal space at the midclavicular line. The mean horizontal thickness was 5.36 cm (SD = 1.19 cm) with angled (perpendicular) thickness slightly less with a mean of 4.86 cm (SD 1.10 cm). Thickness was generally greater than previously reported. An 8-cm angiocatheter would have reached the pleural space in 99% of subjects in this series. Recommended procedures for needle thoracentesis to relieve tension pneumothorax should be adapted to reflect use of an angiocatheter or needle of sufficient length.

Chest Wall Thickness

Treatment of Open-Chest Injury

Monday, April 21st, 2008

Treating an open-chest injury is straightforward. There are, however, techniques that a medic ought to consider. As the video illustrates, identifying the wound is the most important step. Body-composition, position and wound type can complicate doing so. After locating the wound, the basics apply: perform a treatment, assess the treatment, and reassess the treatment after movement and at regular intervals.