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ender18d
10-21-2004, 19:18
I've been asking all of the experienced field medics about this device, and so far most people haven't used it or seen it used.... Does anyone carry this in their aid-bag?

I got the chance to administer a Cook Catheter in Tampa, and had a great long talk about this device with a Doc at Ireland Army Hospital at FT Knox during my SOC-T...

The kit is light, self contained, and small... a negligable space or weight concern. Basically a nice big flexible cath with (if I remember correctly) some additional fenstrations. Inserts 2nd ICS MCL just like a standard decompression, but has built-in Heimlich and can be connected to standard pleurevac. In Tampa we used this device for definitive care on a roughly 30% spontaneous left-side pneumo, and X-rays demstrated full efficacy of treatment. The docs at both hospitals said that it is very common that this device can eliminate the need for a more invasive and painful chest-tube. This seems ideal to me for field use as an alternative to many chest-tubes, particularly for the borderline cases, such as a GSW to chest that must go on a bird, but may not display S/S of pneumo. I'd sure hate to stick a field-finger in that guy's pleural space, but this needle might be a good compromise.

Anyone have any experience or thoughts on this type of device?

http://www.armstrongmedical.com/ami/item.cfm?sction=3&sbsection=16&category=71&itemid=721

greg c
10-22-2004, 16:20
I've never used the kit, but the premise is similar to most other pleural space catheter kits.

I'd be careful preemptively sticking one in a GSW that has no Sx- if he's not got a pneumothorax, you might stick that needle into the lung. You'll get a nice air return, and then you'll confidently stick that catheter right into lung tissue. Oops.

ender18d
10-22-2004, 16:33
Thank you-- that brings up another question I had...

I was trained in the schoolhouse that *anyone* with a penetrating chest wound should get a chest tube prior to air evac, even without S/S... this always seemed like *Very* aggressive treatment to me (and is one of the reasons I was particularly enthused about this cath, as a compromise for the air-evac patient)... since the chest tube is an austere environment is very far from ideal, albeit sometimes a neccessary lifesaving procedure. What guidelines are appropriate as to when either chest-tube or the cook cath should be used for an air-evac patient? I'm quite comfortable as far as treatment thresholds for ground patients, but how much more aggressive should I be if he's potentially going to be exposed to pressure changes that could gravely excacerbate a condition that's barely detectable on the ground. I can imagine how the chest tube represents less danger to a (possibly) inflated lung than the cath needle...

Any thoughts?

52bravo
10-22-2004, 18:08
IDF has do som thing aboute chest tube air-evac, one doc from talled my that you use to must time on it. time s life so needel them.
Mattox say the same chest take time get the pt. to the OP save life.

Sacamuelas
10-22-2004, 18:31
IDF has do som thing aboute chest tube air-evac, one doc from talled my that you use to must time on it. time s life so needel them.
Mattox say the same chest take time get the pt. to the OP save life.

Running that through my intoxicated 'dutch to english' translater ;) LOL.. I get the following.

IDF has protocols about chest tubes in air-evac scenarios. One Doc told me that you use up to much time placing it without the symptoms indicating its need. Time is life.. so needle decompress them instead. Doc Mattox says to save the precious time and get the patient to the higher level care (OP) to save his life.

How did I do Bravo? :D

52bravo
10-22-2004, 18:35
my hero sorry i know my english is bad :)

just one thing dr mattox is from tex,us and know to all who work in trauma care

24601
10-22-2004, 19:39
So, this is used just like a normal emergency one done with a needle and IV catheter? It looks like a good kit, nice for EMS. Not that expensive either, considering how many I know of being done back home. how large is the reservoir, and how easy is it to drain?

swatsurgeon
10-26-2004, 18:32
save money, buy the Cook decompression needle...it is wire wrapped therefore can't kink, and buy a 'mini' fish tank line valve at walmart for $1.09...this is what I carry for tactical field care. When I get back home I'll photo it and post it
T-2

swatsurgeon
11-02-2004, 11:38
Here is the pic I promised...the Cook Catheter "Emergency Transtracheal Airway Catheter" that is wire reinforced so it can't kink and the one way in-line fish tank valve (the exact same as the large Heimlich valve in the PTX kit only much smaller) from Walmart that I had sterilized at the hospital. Alot less money than the PTX kit they sell and infact I've been working with my Cook rep to add this to their equipment line.

24601
11-02-2004, 19:26
Sorry to sound like an idiot (long week), but that acts as a flutter valve then?

swatsurgeon
11-03-2004, 06:50
yes, of sorts. It allows air out but not in. It is molded rubber (latex) just like the large ones we use in the hospital...like a woopie cushion, when the air goes through it the 2 'leaves' of latex separate, a pleasant noise is heard, then they naturally collapse back together preventing any air from re-entering the system. It's identical to the $150 Heimlich valve we use for chest tubes. This little valve also would allow fluid to escape as well as air. It's a temporary fix, not a permanent one. The idea of placing a chest tube in a hot zone is crazy....TCCC does not suggest that chest tubes are places in the field, just needle decompression. And best to do it with a needle that can't kink off and re-create a tention PTX and the one way valve 'closes' the system and potentially evacuates the simple PTX and 'open chest wound phenomemon'

24601
11-03-2004, 16:39
Sounds safer and better than the glove tip I've had to do before. I was looking for the chest seals we have here, but I think hubby took them to work for the platoon medic. That's what I meant by a "flutter valve".

How heavy is that, for how it's used? Is it easy to secure in place, or do you need rolled gauze around it?

swatsurgeon
11-03-2004, 17:55
the catheter weighs more than the fish valve I think...it's very light weight and since the catheter is wire wrapped, it can 'flop' over and not kink...just tape it to the skin

Were you thinking of Asherman's chest seal for open chest wounds?
I hate the glove trick especially if the gloves have powder on them...and if done incorrectly, it clogs the catheter and the tension PTX is back.

24601
11-03-2004, 20:17
Yeah, I was refering to an Asherman's chest seal. I got distracted, and ment to edit to add that. I hate the glove too, luckly we only had non powdered in the rig. I'm going to have to look at this more when/if I get hired up here and geton a rig. Going through the fire training has me a little worried. :eek:

Thank you for the info, and putting up with all my questions. I'm always looking for new ways to try things and new things to learn.

damion18d
11-26-2004, 02:04
Here is the pic I promised...the Cook Catheter "Emergency Transtracheal Airway Catheter" that is wire reinforced so it can't kink and the one way in-line fish tank valve (the exact same as the large Heimlich valve in the PTX kit only much smaller) from Walmart that I had sterilized at the hospital. Alot less money than the PTX kit they sell and infact I've been working with my Cook rep to add this to their equipment line.How good is the connection between the cath and the fish valve? The ends of both look rigid.
As a side note. I have to say, that is really ingenius.

swatsurgeon
11-26-2004, 06:28
The connection is solid. There is enough friction between the plastic of the valve and metal of the needle that you will have to put in a good amount of effort to get them apart.... This is the setup I use for tactical medicine (civilian world) and teach in our classes.

Mr. Freeze
11-29-2004, 14:03
Swatsurgeon, if I may:

Are you leaving the needle part of the cath setup in the pic you've shown and hooking the valve to that once you've inserted into ICS?
And does the valve just fit right on?

The "kit" we have is the glove finger/long 14G IV/syringe roll, but obviously this seems much better.

I've lurked for awhile because I certainly have more to learn than share, but we were just talking about decomp setups at work last shift and I had to check the pic of the valve.

Thank you guys for all the knowledge you pass on...

swatsurgeon
11-30-2004, 06:55
Mr. Freeze,
the needle is removed once the catheter is inserted, just like a 'jelco' or 'angiocath'. The catheter that remains is wire coated so it won't kink (loss of functional lumen) despite being bent. The valve fits right on to the leur lock and those two pieces remain intact until such time that a proper chest tube can be placed. The longest I've had this combo in place was 4-5 hours and as long as the patient is breathing spontaneously they can inspire deeply and valsalva to evacuate more air and at worst they have a simple pneumothorax which is well tolerated by most people and avoid a tension pneumothorax which is tolerated by few if any people, at least not for a prolonged period of time.