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I havnt been on this sight in over a year but I just did a quick scan of the last few pages of posts and didnt see any mention of large bore needles for chest decompression. The basic use for this is to treat tension pneumothorax which is commonly caused by penetrating trauma to the chest and is referred to as a “sucking chest wound.” The basic mechanism of injury is the knife/bullet/penetrating object punches a hole in the skin over the lungs and allows air to get sucked into the normally empty pleural “space” that surrounds the lungs and acts as a lubricant layer during normal breathing to keep your lungs from grinding against the muscles under the chest.
Primary treatment of tension pneumothorax involves taping a square occlusive airtight dressing over the wound on 3 sides, leaving the 4th side open to allow escape of air from the sucking chest wound. In reality this usually doesnt do very much to treat the injury but usually just prevents further air from getting sucked in. The real treatment involves going to the emergency room/trauma center and getting a chest tube, but this is not pre-hospital treatment nor is it feasible to carry a chest tube EDC.
Paramedic Level prehospital treatment involves the use of a large bore IV needle, typically 14 gauge x 3″ pushed between the ribs and into the pleural “space” to allow any trapped air to vent out. If properly done you hear a loud pop and hiss of air escaping and the patient will feel immediate relief. Theres no guarantee this will work, you may need additional decompression and its only temporary until you can get to the ER. It may also cause a tension pneumothorax if one didnt already exist.
This is a high level advanced technique and legally in my state, an off duty paramedic is NOT allowed to do it, because its considered ALS (Advanced Life Support) and only BLS (Basic) is allowed when you are “off the clock” and not working under the medical directors indirect supervision and protocols.
I am not a lawyer but I would strongly advise NOT using this technique on anyone that you are not willing to risk suing you and also that you feel will imminently die if you do not do it. I would also advise you NOT try it unless you can somehow get some training from a paramedic or doctor and practice finding the proper sites of insertion on friends/family with their shirts off.
Additionally, even if you choose not to ever perform this technique, which I strongly advise no one who is not at least an EMT-B do – you may want to carry the needle in your EDC kit so that if you get hurt a medic/doctor can do the technique on you if they dont have one available. Or you may be conscious enough to do it to yourself, which is probably more of a movie fantasy than a reality.
The purpose of this post is to share knowledge not necessarily advocate carrying a 14ga catheter to all people. Please google key words from this post such as “needle decompression” if you want further info.
Additionally I carry a small one way valve from an aquarium tubing kit to insert into the end of the catheter to prevent air from entering the pleural cavity through the catheter after its inserted.
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