needle decompression

February 18, 2000

Just asking for some input on yalls best thoughts on needling the chest and what yall used( 14ga. with a glove ) ? On another note have yall heard about the new 12 lead patches and the new sterum

IO needles? Do yall have any of you used these in the field?<<<< you can lead a horse to water butyou can't make him drink>>>>>>born 150 years to late ??? cowboy up!?

February 19, 2000

Glove fingers won't work because they're too rigid and don't collapse.

Condoms are the preferred device. The BTLS Manual confirms this and says

absolutely that glove fingers won't work. If the only thing you have is a

glove, use the whole glove. Poke the 14g through the " we're # One " finger

and leave the whole glove attached. It will be a better one-way valve. My

preference outside of commercially available products like the McSwain Dart

are to puncture the pulmonary space with a 14, withdraw the needle, and

immediately attach a syringe with the plunger taken out and a condom secured

over the end with tape or dental floss to the catheter. You can cut just a

bit of the tip of the condom off with your scissors and it will make a great

one-way valve. Or, Penrose tubing will also work if you want to make this up

in advance. The finger of the glove will not work because it won't collapse

sufficiently, and since the BTLS Manual specifically states that it won't

work, if you use it you're going to be looking at a Standard of Care issue if

suit is filed.

I regret to say that most services have not addressed this question and do

not carry condoms on the unit. This is an area where medical directors have

fallen behind and are not " with it " as far as practical applications go.

Simply allowing " needle decompression with a 14g needle/catheter " does not

address the practical problems associated with this procedure. So if your

service doesn't provide condoms on the unit, carry some in your duty bag.

Just for info, If I go to work on a unit, I carry the following: A box of

plastic Leaf Bags, some Veterinary palpation gloves which come to the armpit,

some plastic ties to use as restraints (at least one dozen) and a chest

decompression device consisting of a 5 ml syringe with 6 inches of flat

Penrose drain tubing attached for attachment to the hub of the 14g cath that

is left in place when you decompress.

The leaf bags are for putting clothing and personal items you cut off and

remove from the patient; if the patient is incontinent, you can put your arms

in the leaf bag up to your shoulders and place your arms under the patient to

move him/her from the nursing home bed to your cot, if the patient is

vomiting you can tie it around his neck and it gives you a LARGE reservoir of

vomit plus the ability to just tie the string pulls up and close it off, and

other uses you can imagine. When you move an incontinent patient to you cot,

leave the bag in place and then when you get to the hospital, reinsert your

arms in the bag and pull the patient over onto the hospital gurney and then

leave it in place. You're protected from their urine and feces.

Good luck and good practice!

Gene Gandy, JD, LP

EMSP Program Director

Tyler Junior College

February 19, 2000

Now this is GREAT information. Thanks.

GG

February 19, 2000

" I regret to say that most services have not addressed this question and do

not carry condoms on the unit. "

Gene--

it has been my experience in EMS that the probable reason that condoms are

not stocked on the ambulances is that there are so many people in EMS who

are sleeping with one another. Therefore, if condoms were stocked, it would

make it too convenient for those that wish to be members of the " Code Three

Club! "

(At least I see the humor-- sick as it is-- in that statement!) <g> :-)

Brad

Re: needle decompression

> Glove fingers won't work because they're too rigid and don't collapse.

> Condoms are the preferred device. The BTLS Manual confirms this and says

> absolutely that glove fingers won't work. If the only thing you have is a

> glove, use the whole glove. Poke the 14g through the " we're # One " finger

> and leave the whole glove attached. It will be a better one-way valve.

My

> preference outside of commercially available products like the McSwain

Dart

> are to puncture the pulmonary space with a 14, withdraw the needle, and

> immediately attach a syringe with the plunger taken out and a condom

secured

> over the end with tape or dental floss to the catheter. You can cut just

a

> bit of the tip of the condom off with your scissors and it will make a

great

> one-way valve. Or, Penrose tubing will also work if you want to make this

up

> in advance. The finger of the glove will not work because it won't

collapse

> sufficiently, and since the BTLS Manual specifically states that it won't

> work, if you use it you're going to be looking at a Standard of Care issue

if

> suit is filed.

>

> I regret to say that most services have not addressed this question and do

> not carry condoms on the unit. This is an area where medical directors

have

> fallen behind and are not " with it " as far as practical applications go.

> Simply allowing " needle decompression with a 14g needle/catheter " does not

> address the practical problems associated with this procedure. So if your

> service doesn't provide condoms on the unit, carry some in your duty bag.

>

> Just for info, If I go to work on a unit, I carry the following: A box of

> plastic Leaf Bags, some Veterinary palpation gloves which come to the

armpit,

> some plastic ties to use as restraints (at least one dozen) and a chest

> decompression device consisting of a 5 ml syringe with 6 inches of flat

> Penrose drain tubing attached for attachment to the hub of the 14g cath

that

> is left in place when you decompress.

>

> The leaf bags are for putting clothing and personal items you cut off and

> remove from the patient; if the patient is incontinent, you can put your

arms

> in the leaf bag up to your shoulders and place your arms under the patient

to

> move him/her from the nursing home bed to your cot, if the patient is

> vomiting you can tie it around his neck and it gives you a LARGE reservoir

of

> vomit plus the ability to just tie the string pulls up and close it off,

and

> other uses you can imagine. When you move an incontinent patient to you

cot,

> leave the bag in place and then when you get to the hospital, reinsert

your

> arms in the bag and pull the patient over onto the hospital gurney and

then

> leave it in place. You're protected from their urine and feces.

>

> Good luck and good practice!

>

> Gene Gandy, JD, LP

> EMSP Program Director

> Tyler Junior College

>

> ------------------------------------------------------------------------

> Get what you deserve with NextCard Visa! ZERO! Rates as low as 0.0%

> Intro or 9.9% Fixed APR, online balance transfers, Rewards Points,

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> http://click./1/914/3/_/4981/_/951027132/

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> -- Create a poll/survey for your group!

> -- /vote?listname= & m=1

>

February 20, 2000

For a countryboy rig, (OK, countryperson), a 14 x 2 inches works with a WHOLE

glove (not just one finger; stick the needle and cath throught he middle

finger) or a condom. TIP: Leave the condom rolled till you get air return.

Makes it a whole lot easier to withdraw the needle. Then you can unroll it.

I like to take a 5 cc syringe, take the plunger out, tie the condom over

the backend with some dental floss and cut the very tip off the condom. Once

you stick and get air return you withdraw the needle and attach the syringe.

Then you can put a stack of 4x4s cut to the center around the hub and tape it

securely. You can see what's going on when the condom inflates or collapses

and you can easily see chest rise and fall.

Now some others have mentioned other rigs with 10g and 8g needles and fish

valves. Somebody mentioned using a scalpel to make the cut if you're not

using an over the needle cath so that you don't get tissue in the middle of

the needle. If you're using an over the needle cath, then you don't have

that problem. You could use an 8 or 10 gauge trocar like we use to

decompress a bloated bovine also, but unless your medical director is a

veterinarian you might have trouble convincing them that would work!

Then there's the commercial McSwain Dart which is about an 8 incher with a

mollybolt type arrangement on the end and a Heimlich valve. Those would be

the hair on the pig if your service would spend the money for them.

Gene Gandy, JD, LP

EMSP Program Dir

Tyler Junior College

February 20, 2000

Brad,

And I thought my biggest problems was finding out who is drinking the

patients water that we carry in the event one is thirsty.

Henry

Brad Woodall wrote:

"I regret to say that most services have not addressed

this question and do

not carry condoms on the unit."

Gene--

it has been my experience in EMS that the probable reason that condoms

are

not stocked on the ambulances is that there are so many people in EMS

who

are sleeping with one another. Therefore, if condoms were stocked,

it would

make it too convenient for those that wish to be members of the "Code

Three

Club!"

(At least I see the humor-- sick as it is-- in that statement!) <g>

:-)

Brad

Re: needle decompression

> Glove fingers won't work because they're too rigid and don't collapse.

> Condoms are the preferred device. The BTLS Manual confirms

this and says

> absolutely that glove fingers won't work. If the only thing

you have is a

> glove, use the whole glove. Poke the 14g through the "we're

# One" finger

> and leave the whole glove attached. It will be a better one-way

valve.

My

> preference outside of commercially available products like the McSwain

Dart

> are to puncture the pulmonary space with a 14, withdraw the needle,

and

> immediately attach a syringe with the plunger taken out and a condom

secured

> over the end with tape or dental floss to the catheter. You

can cut just

a

> bit of the tip of the condom off with your scissors and it will make

a

great

> one-way valve. Or, Penrose tubing will also work if you want

to make this

up

> in advance. The finger of the glove will not work because it

won't

collapse

> sufficiently, and since the BTLS Manual specifically states that

it won't

> work, if you use it you're going to be looking at a Standard of Care

issue

if

> suit is filed.

>

> I regret to say that most services have not addressed this question

and do

> not carry condoms on the unit. This is an area where medical

directors

have

> fallen behind and are not "with it" as far as practical applications

go.

> Simply allowing "needle decompression with a 14g needle/catheter"

does not

> address the practical problems associated with this procedure.

So if your

> service doesn't provide condoms on the unit, carry some in your duty

bag.

>

> Just for info, If I go to work on a unit, I carry the following:

A box of

> plastic Leaf Bags, some Veterinary palpation gloves which come to

the

armpit,

> some plastic ties to use as restraints (at least one dozen) and a

chest

> decompression device consisting of a 5 ml syringe with 6 inches of

flat

> Penrose drain tubing attached for attachment to the hub of the 14g

cath

that

> is left in place when you decompress.

>

> The leaf bags are for putting clothing and personal items you cut

off and

> remove from the patient; if the patient is incontinent, you can put

your

arms

> in the leaf bag up to your shoulders and place your arms under the

patient

to

> move him/her from the nursing home bed to your cot, if the patient

is

> vomiting you can tie it around his neck and it gives you a LARGE

reservoir

of

> vomit plus the ability to just tie the string pulls up and close

it off,

and

> other uses you can imagine. When you move an incontinent patient

to you

cot,

> leave the bag in place and then when you get to the hospital, reinsert

your

> arms in the bag and pull the patient over onto the hospital gurney

and

then

> leave it in place. You're protected from their urine and feces.

>

> Good luck and good practice!

>

> Gene Gandy, JD, LP

> EMSP Program Director

> Tyler Junior College

>

> ------------------------------------------------------------------------

> Get what you deserve with NextCard Visa! ZERO! Rates as low as 0.0%

> Intro or 9.9% Fixed APR, online balance transfers, Rewards Points,

> no hidden fees, and much more! Get NextCard today and get the credit

> you deserve! Apply now! Get your NextCard Visa at:

> http://click./1/914/3/_/4981/_/951027132/

>

> -- Create a poll/survey for your group!

> -- /vote?listname= & m=1

>

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February 20, 2000

I'm just cutting a teeny teeny bit off the end. Just one needle

stick-through probably won't allow enough air to get out. As for wetting or

lubrication, I've never considered that. Probably would be OK. Can't see

any downside to it. The main thing is for people not to think that they can

cut one finger off a glove and use it as an effective one-way valve.

Anything else that works is great.

The idea is to let air out without letting air in. So anything that

accomplishes that works.

Gene G.

February 20, 2000

Oops. Didn't comprehend all your post. With the condom tied over the barrel

of a syringe there is no needle sticking through it, so it is a balloon on

the back end of the syringe where the plunger would normally be. Air is

going in that direction and the condom is letting it out. This is the

opposite of where you stick the needle through the end of the condom and the

tip is toward the hub of the catheter. In this technique the condom is

wrapped around the hub of the syringe and the business end is at the opposite

end. Wish I had a picture, but hope this helps to explain it.

Gene G.

February 20, 2000

I'll bet it would. Anyway, whatever works, works!

Gene

February 20, 2000

I was not aware of that. Tell me where and what to ask for.

Gene G.

February 20, 2000

Mr. ,

I am going to take a shot at answering your question, then give my " Oopsie "

fix tip for needle decompression.

" Why use a condom or a big floppy glove to do the job when there is

something better " ? Cheap Son-of-a-Guns in the managers office. I actually

had to threaten a past employer with calling the state and reporting him if

he didn't restock the expired lidocaine on the ambulance. In an effort to

save money he bought 1% lidocaine. Now this will work, you just have to give

twice as much. NOT fun down the ET tube, but they didn't see that as an

issue. Oh, the total savings on the lidocaine was like $5 for the batch. Do

you think someone like that would spend the money on nifty toys we would

" never use " ?

Okay, the " Oopsie " fix of the day. My first ever needle decompression was

done with a 14g 1 1/4 inch catheter on a multisystem trauma patient. I

calmly suggested this technique to a fellow Paramedic, expecting her (who

had been one longer) to have done it. After the, " Okay, go for it " reply

from her, I went for it.

I palpated the 2nd intercostal space, swabbed with betadine, and inserted

the catheter. In the heat of the moment (as it was 120 degrees out, it was

literally in the heat of the moment) I had forgotten two important things.

1> I had forgotten to put the needle through a glove. 2> I had forgotten to

pull the back of the flash chamber off.

Now, neither of these is really a big deal. The flash chamber rather

dramatically blew off and struck my safety glasses at about mach 1, pushing

about 1/2 of the needle out of the catheter in the process. Needless to say,

I was VERY confident that the patient had had a tension pneumo after that.

As for fixing the no glove tip thinger: I put a simple occlusive dressing,

taped on three sides, over the catheter. You all should know the dressing I

am talking about, the one you are taught in EMT-B to use on " sucking chest

wounds " . That worked quite well for about 3 minutes until the lady quite

deliberately reached up and pulled the whole thing out. But that is a story

for another time.

Good luck,

Webb, EMT-P

FLW EMS, MO

______________________________________________________

February 20, 2000

Gene:

I have heard that wetting the glove or condom helps to keep the air from reversing and causing a sucking-type opening. Do you find this to be true? Without being too gross, I guess lubricated condoms would work better for this?

" I like to take a 5 cc syringe, take the plunger out, tie the condom over

the backend with some dental floss and cut the very tip off the condom. Once you stick and get air return you withdraw the needle and attach the syringe. "

Gene, I am just not getting all of this routine. Why are you cutting the end off of the condom? Isn't that where the needle is inserted through?

Melody

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

For a countryboy rig, (OK, countryperson), a 14 x 2 inches works with a WHOLE

glove (not just one finger; stick the needle and cath throught he middle

finger) or a condom. TIP: Leave the condom rolled till you get air return.

Makes it a whole lot easier to withdraw the needle. Then you can unroll it.

February 20, 2000

Gene:

I have actually seen this work. By wetting the inside of the glove finger or condom the inside collapses on itself and forms a seal of sorts during the " pause " between breaths. This keeps the air from reversing. I'm not sure this would work with a whole glove though. (?)

Melody

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

<< As for wetting or

lubrication, I've never considered that. Probably would be OK. Can't see

any downside to it. The main thing is for people not to think that they can

cut one finger off a glove and use it as an effective one-way valve.

Anything else that works is great.

.. . .

The idea is to let air out without letting air in. So anything that

accomplishes that works.>>

February 20, 2000

A one way aquarium valve works great. Many ems and air medical services use them. They are small and fit right on the end of the cath.

Why use a condom or a big floppy glove to do the job when there is something better????