Percussing the pneumo

[mshow00]

A simple question... Do you really percuss the chest of a "suspected" pneumo to determine if/which side the pt requires a decompress? It is a simple enough trick of the trade, but how practical is it? My paramedic instructor is teaching us to do it, but then says stuff like don't worry so much about heart sounds in the back of the rig as they are too hard to hear, don't listen to bowel sounds as it takes six minutes(you would be at the hospital by then here) etc. Just trying to get some impute here, Thank you.

[hammerpcp]

Good skills to know, however they take practice to be useful and you won't get to practice much in the field. Ambient noise is something we can do very little about in EMS.

[spenac]

I don't like your instructor. I have found that bowel sounds, heart sounds, etc can allow me to at least give the hospital more heads up even if it does not change my care many times. I disagree with dumbing down just because of short transport. But keep in mind I am in a rural area and also am a firm believer in a detailed exam. I percuss, I expose, I look, I listen, I feel, etc. The more complete I am the less likely I am to miss something and the more details I can provide the hospital so that my patient gets the best care from me and those that follow.

[mshow00]

I don't like your instructor. I have found that bowel sounds, heart sounds, etc can allow me to at least give the hospital more heads up even if it does not change my care many times. I disagree with dumbing down just because of short transport. But keep in mind I am in a rural area and also am a firm believer in a detailed exam. I percuss, I expose, I look, I listen, I feel, etc. The more complete I am the less likely I am to miss something and the more details I can provide the hospital so that my patient gets the best care from me and those that follow.

Allow me to expand a little on what he was saying, they are important however with a seriously short transport time (5 mins or less in our area), there are more important things we need to gather...

[fiznat]

I've been reading a lot about percussing recently and I would like to try it more often, but like others have said I don't often get the opportunity given short transport times and a long list of other things to get done. I'm also not convinced that the information I get from percussing will really be that valuable. If the patient doesn't have other signs + symptoms of a pneumo or SOB, I'm not sure that my (novice) percussion exam would really make me feel strongly enough to decompress a chest.

[AnthonyM83]

Isn't decreased lung sounds the criteria used to choose which side to decompress? It was explained to me that percussing helps decide whether it's a pneumo or hemopneumo.

But yes, I agree with at least being practiced with percussing during your training. If you end up working in an area with such short transports you hardly get to do it, you'll at least have the base knowledge in case you ever move systems or for some reasons have delayed transport.

[fiznat]

You can have a pneumo and still have "lung sounds" on both sides. Sometimes you hear sounds on the affected side resonating from the good side and it is hard to tell which is which. Percussing helps in those instances which, admittedly, are rare.

[MSDeltaFlt]

Isn't decreased lung sounds the criteria used to choose which side to decompress? It was explained to me that percussing helps decide whether it's a pneumo or hemopneumo.

But yes, I agree with at least being practiced with percussing during your training. If you end up working in an area with such short transports you hardly get to do it, you'll at least have the base knowledge in case you ever move systems or for some reasons have delayed transport.

That's just the thing. It helps. It's not all inclusive or exact, but it's still something you definitely need to learn.

[Dustdevil]

Agreed with Delta. You don't know if you can hear it until you try. And there is more to it than what you hear. It is also what you feel, which is developed with a lot of practice. It is something that should be attempted until you know for sure that it cannot be done.

If your instructor is saying it's a waste of time, he either isn't very good at it, or else he's been in a crappy urban system for too long. I don't even get what he is saying. Is he saying to just dart every patient bilaterally instead of trying to localise the pneumo? Or is he saying you don't need to dart at all?

[AnthonyM83]

You can have a pneumo and still have "lung sounds" on both sides. Sometimes you hear sounds on the affected side resonating from the good side and it is hard to tell which is which. Percussing helps in those instances which, admittedly, are rare.

Copy. The protocols I've read say to use diminished LS only to determine which lung...but I keep forgetting I'm in my crappy Los Angeles bubble ...