Remind me again please

[NousDefionsDoc]

Originally Posted by swatsurgeon

NDD,
I agree with the larger tube for penetrating trauma...first off, chest tubes have little to no place in the field, yes in an aid station or FAST area, but not under fire. The smaller tube is under ideal conditions with a 'pure' pneumothorax, popped bleb, stab wound, etc. For the typical need for a battle field chest decompression, stick with a needle.

Cool. Thanks.

How often do you think needles actually enter the chest cavity?

I think most placed by EMS at least tend to stay in the muscle and never break the pleura which is why we have stopped routinely placing tubes and getting xrays to verify unless the patient is unstable. Often the catheter is simply not long enough in a heavy or muscular patient.

t.

[TerribleTobyt (RIP)]

ISTR from the lecture a large bore needle into the 7th ICS, mid-axillary line. Palpate the space, slide needle OVER the 7th rib (vice under the 6th rib). If done properly, the patient should express instant relief.

Is that correct, or am I remembering it wrong??

Toby-a chance to cut'sa chance to cure!!!!!!

[swatsurgeon]

the only needles we now have available are 5 cm (2.5 inches) which 'should' be long enough to penetrate the pleura. Doc T is referring to 2 articles from the 90's that showed >65% of all chest decompression needles never made it into the pleural space to decompress the pneumothorax. These needles were the standard 1 1/4 inch IV starter needles....hence why the recommendation for a 2 1/2 inch needle. Some places have gone to a longer HARPOON 5 inch needle but under stressful circumstances this thing is a weapon and can lacerate lung,heart (if put too low) and do more harm than good potentially. The other issue remains that unprotected plastic catheters can bend and kink and the pneumothorax can re-accumulate....
which is why I recommend, and carry, the wire wrapped needles...can tie them into a knot and they retain their lumen. Yes, they are expensive but aren't you worth it?! The bad guy can get the old kind; the soldier, SWAT officer gets the wire wrapped from me.

Question,

I just went throught the PHTLS course up here and one of the instructors said that the placement of a chest tube touches/penetrates one of the 4 (5?) painful "P's", the plura. He had the proceedure once and said that he levitated off the table while trying to whack the Dr. who was placing the tube. Why is the puncture of the plura so painful, and what are the other Painful P's?

Thanks,

Maya