Needle Chest Decompressions and Pneumothorax

[Doc D]

Quick question for my paramedics here. I am a medic in the US Army, we wear IBA and IOTV body armor. Thoracic injuries of penetrating trauma dont really occur often. I would always apply the occlusive dressing, but my question is about the NCD. I havent done it on an actual human being because i havent encountered the injury. I know your preforming the NCD on the 2nd intercostal space, which is right above the 3rd rib. I have done it on training dummies all the time, but my question is on a human being it is hard to feel the third rib to know. Does anyone here know an easier way of identifying the 2nd intercostal space without feeling for the third rib?

[tskstorm]

My best advice for you is to make someone from the unit lay down and count his ribs. You can't be good at it if you don't practice. Further I question your ability to properly perform 12 lead EKG, specifically electrode placement, if you can not properly palpate ribs.

[Doc D]

My best advice for you is to make someone from the unit lay down and count his ribs. You can't be good at it if you don't practice. Further I question your ability to properly perform 12 lead EKG, specifically electrode placement, if you can not properly palpate ribs.

I dont do those other things you listed. The EKG and electrode placement is what EVAC is trained in. I am a front line medic, i work with the supplies in my aid bag. I was just saying because on the training dummies its very easy to find the 2nd intercostal space, but its not so easy on a human being.

[tskstorm]

I dont do those other things you listed. The EKG and electrode placement is what EVAC is trained in. I am a front line medic, i work with the supplies in my aid bag. I was just saying because on the training dummies its very easy to find the 2nd intercostal space, but its not so easy on a human being.

Oh I see, I assumed you were also a Paramedic outside of the ARMY.

http://handbook.muh.ie/trauma/Chest/TensionPneumothorax.html

http://www.tacmedsolutions.com/blog/wp-content/uploads/2010/01/TCCC-Sztajnkrycer-Needle-DC-Prehosp-Disaster-Med-2008.pdf interesting study.

http://www.google.com/imgres?imgurl=http://www.malefi.org/Assets/2007/Med-midclavicle.JPG&imgrefurl=http://www.malefi.org/conference-07-nav.htm&usg=__BykkRx0oq9mEKIrECdUBCscHZa8=&h=1536&w=2048&sz=582&hl=en&start=5&um=1&itbs=1&tbnid=0nCVhgfJzQmMNM:&tbnh=113&tbnw=150&prev=/images%3Fq%3Dneedle%2Bchest%2Bdecompression%2Bvideo%26um%3D1%26hl%3Den%26client%3Dfirefox-a%26rls%3Dorg.mozilla:en-US:official%26channel%3Ds%26tbs%3Disch:1

It really is pretty simple if you practice. As I stated before have different people from the unit lay down and palpate the ribs!

[croaker260]

The 1st IC is roughly under the clavical. COunt down from there. ALso the OC is easier to palpate at the costal -chondral juncture (near the sternum).

May I recommend you also practice your assessment on some of your more attractive female soldiers. You know...to sharpen your skills. In private. SO they feel "safe" with you and your professional demeanor. YOU never know what other skills you may be ...taught.

I am of course assuming you can find a willing, able, and conscious female soldier. If not...there is always the navy.

[tskstorm]

I am of course assuming you can find a willing, able, and conscious female soldier. If not...there is always the navy.

Oh don't pick on the navy, they have enough problems lol

[speedygodzilla]

Unforturnately I do not have an arrange of individuals who would be comfortable with me palpating "ribs." This is especially true with females. Unsure what people are so uncomfortable with.

While experience and practice is always the best bet, I offer another. Know the what you should be feeling for when the opportunities arise. Ok so 1st intercostal space is very easy to find and should be where you start. Find the clavicle and place a finger just below it, than "walk" your fingers down from there counting the softer vs. harder spots. This may require some pressure and a couple tries.

Another option is to feel for the "Angle of Louis" the bump located on the sternum about a quarter the way down from the top of the sternum/suprasternal notch and than proceeding laterally to the left of right as indicated. I have personally found the "Angle of Louis" easier to find on some than others.

This all may be easier if your patient is laying supine or semifowler.

Also remember I was taught that you can introduce the needle on top of the third rib and manuplate it to the 2nd intercostal space a little. Obviously you would have to be at the top of the third rib.

[HERBIE1]

Like assessing lung sounds, the only way to become proficient is to practice. As was mentioned, palpate as many people as possible. Review your A&P, and look for landmarks. One thing to keep in mind- be sure the angiocatheter is long enough for the procedure to be successful- some angios are only 1 inch long, and that is not enough.

[tskstorm]

Like assessing lung sounds, the only way to become proficient is to practice. As was mentioned, palpate as many people as possible. Review your A&P, and look for landmarks. One thing to keep in mind- be sure the angiocatheter is long enough for the procedure to be successful- some angios are only 1 inch long, and that is not enough.

Will a 1/2 inch work ?

[croaker260]

Will a 1/2 inch work ?

Only on kids.

One of the bigger mistakes in doing this proceedure is not using a long enough needle. Here we cary 10 g , 3 1/4 needles for this very reason, although there are some really obese patients you may not hit the pleural space even then.

Steve