Chest Decompression Inquiry

[Matt In Oklahoma]

As I get into chest decompression it seems that there are as many opinions as people on where to place it, when to do it and whether or not to leave the catheter in then placing the chest seal over it. Hopefully keeping it civil I'd like to hear some opinions from some here.
I also have one more small request: It seems when the educated begin making their case on this they start using really large words and uncommon terms. I'm a simple man so please keep it so otherwise you will lose me quickly.

[protus]

As I get into chest decompression it seems that there are as many opinions as people on where to place it, when to do it and whether or not to leave the catheter in then placing the chest seal over it. Hopefully keeping it civil I'd like to hear some opinions from some here.
I also have one more small request: It seems when the educated begin making their case on this they start using really large words and uncommon terms. I'm a simple man so please keep it so otherwise you will lose me quickly.

stick the straw thingy two fingers or so,,unless you got really fat fingers,,above your umm..teet there and stab just under the rib, kinda like cutting ribs for a bbq..oh dont stab to deep or to high......

;) .

im sure more educated and refined people than myself will be along shortly to help you out MIO..
paging doctor Pdog......LOL

[Patriotic Sheepdog]

Sorry I'm late to the ER here...
This is a handout I've used before.

This is a sterile technique. All equipment should be placed within easy access.
A. BSI (Body substance isolation)
B. 14 Gauge 3 inch over-the-needle catheter (14 gauge IV catheter or larger)
C. Flutter valve or one-way valve if available (can be preassembled) [may be a finger cut off a rubber glove with a small cut at the end of the finger area]
1. The flutter valve allows air to escape from the chest, but does not allow air to enter the chest
2. The flutter valve can be home-made or purchased commercially
D. 5-10mL syringe with sterile saline if available

TECHNIQUE: (Always assess the A-B-C

[Patriotic Sheepdog]

As far as placement, it used to be mid axillary 5th intercostal space many years ago (aging myself), then several years ago it went to the chest 2nd intercostal space, but I have been reading some articles over the last year or so that they may want to bring it back to the 5th intercostal space mid axillary. If the patient is on the back the chest will likely be easier to get to. Bottom line, either one will work if done properly.

The chest seal should go on the wound. Just because you have a chest wound does not mean you will have a tension pneumothorax that requires a decompression. If you do place a needle, that will be allowing the air in the chest cavity (not in the lungs) to escape and decrease pressure which is causing compression of the good lung, chest vessels and heart. If you then cover that needle up with a seal, you have defeated the purpose of the needle.

Hope that helps and I just can't help using some big words. I mean I spent a lot of money learning those words so I just gotta use um. LOL


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[Matt In Oklahoma]

As far as placement, it used to be mid axillary 5th intercostal space many years ago (aging myself), then several years ago it went to the chest 2nd intercostal space, but I have been reading some articles over the last year or so that they may want to bring it back to the 5th intercostal space mid axillary. If the patient is on the back the chest will likely be easier to get to. Bottom line, either one will work if done properly. Ok that make sense and that's what a lot of them are arguing about, side or top, and the big wordy dudes get all bent bout the side of the chest being used but I've seen Army Medics do it all the time.

The chest seal should go on the wound. Just because you have a chest wound does not mean you will have a tension pneumothorax that requires a decompression.got it If you do place a needle, that will be allowing the air in the chest cavity (not in the lungs) to escape and decrease pressure which is causing compression of the good lung, chest vessels and heart. If you then cover that needle up with a seal, you have defeated the purpose of the needle. Ok, makes sense and I think one of the seals has the valve thing to put the needle up thru

Hope that helps and I just can't help using some big words. I mean I spent a lot of money learning those words so I just gotta use um. LOL
I know but I'm ignorant

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We might possibly have someone that is going to teach us soon and maybe come onboard but that is still a ways away. I thought it was pretty straight forward, wouldn't call it simple as it stresses me some, put the sharp thingy here or here and dont poke the dodad and try not to panic but as I study this online the opinions started flying and it was all doom n gloom n imminent death, which is a real possibility if I'm working on you anyway but I don't wanna do it wrong and cause it.
Thanks for the help

[xdpatriot]

Applying a three sided tape to a chest wound in a tactical environment isnt impossible, but with the movement you're going to experience, and if you're talking about post SHTF, it's PROBLY not worth the stress to patient and/or effort. my 2 cents

[Patriotic Sheepdog]

The other thing to consider in a PAW scenario is...
What do you do after you place the needle? That's not the final step in correcting this problem you know. Don't get me wrong, you need to know how to do it, but after the needle goes in and they start improving a bit, they aren't out of the woods yet!


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[Matt In Oklahoma]

The other thing to consider in a PAW scenario is...
What do you do after you place the needle? That's not the final step in correcting this problem you know. Don't get me wrong, you need to know how to do it, but after the needle goes in and they start improving a bit, they aren't out of the woods yet!
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Yep thought of that with several issues. Cowboys and mt men had a short lives for a reason. I have even considered if on a few things like this its better just to not. The reason I'm wanting this is more pre-paw but away from good medicine. It doesn't take a gunshot to get one, it can be a car wreck, sharp branch from a fall while hunting, flying metal from a tornado etc.

[xdpatriot]

Yep thought of that with several issues. Cowboys and mt men had a short lives for a reason. I have even considered if on a few things like this its better just to not. The reason I'm wanting this is more pre-paw but away from good medicine. It doesn't take a gunshot to get one, it can be a car wreck, sharp branch from a fall while hunting, flying metal from a tornado etc.

Good point, good point.

[Matt In Oklahoma]

If you then cover that needle up with a seal, you have defeated the purpose of the needle.

This was what I was talking about with the Ashermans chest seal

so this is correct?

[Patriotic Sheepdog]

Well, what we don't know is what kind of tension pneumothorax the patient has....open or closed. If she was treating a closed tension pneumothorax then that would be an acceptable treatment option. Now, you just used a needle and one of your Ascherman seals. You cannot resupply either in the PAW. Can you accomplish the same thing by making a flutter valve out of a finger of a rubber glove? All the Ascherman does is help "secure" it and offer the flutter valve.

If she was treating an open pneumothorax, then the Ascherman should be all she needed.

Here are some pages from trauma.org that may help.

Open Pneumo:

http://www.trauma.org/archive/thoracic/CHESTopen.html

Closed Pneumo:

http://www.trauma.org/index.php/main/article/199/

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[Matt In Oklahoma]

awesome thanks!

[Patriotic Sheepdog]

You're welcome, stay safe.


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