11-28-2005, 12:39
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#16
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Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
Posts: 880
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MOOBOB,
which gauge and length needle were you shown to use?
ss
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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swatsurgeon is offline
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11-28-2005, 19:55
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#17
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Auxiliary
Join Date: May 2005
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If I remember correctly they were 18gauge. Don't remember the length. Some of us did use a different size to stick the rubber training chest things, but I believe we were told to use the 18's.
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moobob is offline
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11-28-2005, 20:09
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#18
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Quiet Professional
Join Date: Jan 2004
Location: Tampa
Posts: 2,535
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Quote:
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Originally Posted by swatsurgeon
MOOBOB,
which gauge and length needle were you shown to use?
ss
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SS-
Standard is a 16ga angiocath...
problem with the CLS "bag" is that it doesn't come stocked from DOD with any 16ga's inherant.
Eagle
__________________
Primum non Nocere
"I have hung out in dangerous places a lot over the years, from combat zones to biker bars, and it is the weak, the unaware, or those looking for it, that usually find trouble.
Ain't no one getting out of this world alive. All you can do is try to have some choice in the way you go. Prepare yourself (and your affairs), and when your number is up, die on your feet fighting rather than on your knees. And make the SOBs pay dearly."
The Reaper-3 Sep 04
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Eagle5US is offline
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11-29-2005, 01:51
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#19
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Join Date: May 2005
Location: NC
Posts: 93
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Quote:
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Originally Posted by Eagle5US
SS-
Standard is a 16ga angiocath...
problem with the CLS "bag" is that it doesn't come stocked from DOD with any 16ga's inherant.
Eagle
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Now that you mention it, that's what we were told to use. I'm definitely going to make time to study the CLS material some more. The class was great training, but I feel like the guy out of the Holiday Inn Express commercial. I'm not a medic but I did stay at a...
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11-29-2005, 09:34
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#20
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Guerrilla Chief
Join Date: Jul 2004
Location: Phoenix, AZ
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the reason I asked length is because 2 studies demonstrated that up to 50-60% of the 1 1/4 inch needles never make it into the chest (pleural space) to actually decompress the pneumothorax. You need a 5 cm (2 1/2 inch) needle to reliably enter the pleural space.....especially with the more muscular male bodies.
My 2 cents is that if they are not stating this in the class (using the 5cm needles), have the instructors do a literature search on it and find the articles (i don't have the references handy)....They should be teaching and equipping you with the best information and supplies that will get the job done reliably, efficiently and safely.......
ss
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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swatsurgeon is offline
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11-29-2005, 11:45
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#21
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Quiet Professional
Join Date: Jan 2004
Location: Tampa
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Quote:
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Originally Posted by swatsurgeon
the reason I asked length is because 2 studies demonstrated that up to 50-60% of the 1 1/4 inch needles never make it into the chest (pleural space) to actually decompress the pneumothorax. You need a 5 cm (2 1/2 inch) needle to reliably enter the pleural space.....especially with the more muscular male bodies.
My 2 cents is that if they are not stating this in the class (using the 5cm needles), have the instructors do a literature search on it and find the articles (i don't have the references handy)....They should be teaching and equipping you with the best information and supplies that will get the job done reliably, efficiently and safely.......
ss
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An excellent point SS...thanks for pointing that out. Sometimes we take this type of information for granted.
Eagle
__________________
Primum non Nocere
"I have hung out in dangerous places a lot over the years, from combat zones to biker bars, and it is the weak, the unaware, or those looking for it, that usually find trouble.
Ain't no one getting out of this world alive. All you can do is try to have some choice in the way you go. Prepare yourself (and your affairs), and when your number is up, die on your feet fighting rather than on your knees. And make the SOBs pay dearly."
The Reaper-3 Sep 04
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Eagle5US is offline
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11-30-2005, 06:09
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#22
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Auxiliary
Join Date: Jun 2004
Location: Odense Denmark
Posts: 77
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ON the length.
there are to study on it. one where use ultrasound on non-wounde and one where thay use CT one thorax trauma, if i rember right the CT study found that in 75% you can use a normal IV 14g 1.77in, but in 25% the cutan emfysem the musculature made it impossible, and also in female it impossible. it a ok large study.
the ultrasound had the same result, i think i was impossible in 15%.
there is also a lot of case repports on it so it is not new, but in ATLS thay dont point it out, i think the reson for taht is that when you use needl, you also put in a tube.
the study also say, that you have to use a 3in to get all, and most i know who has use it says 14g is on the small side, and that will go for 12gor10g
i if i rember it right, in have them on my computer one place.
and
__________________
If we are going to ask one of our combat medics to undertake a medical treatment in the middle of a firefight, then we need to be as sure as possible that the benefit resulting from this treatment is going to be worth the risk.
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52bravo is offline
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11-30-2005, 09:09
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#23
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your data was alittle flawed. The article you cited was from Acad Emerg Med, 2004, Feb:11;211-13. It stated a 5 cm needle would decompress 75% of all chests. Interestingly it also stated that females had a thicker chest wall....was this a civilian female or military??? With obesity so rampant here I can believe that fact if it was NON-military women. Otherwise the 5 cm should do it. We have seen "harpoons" used at other hospitals that have infact stuck into the heart and the lung and made matters worse not better...hence why 5 cm was the 'best alternative'.
I'm still looking for my original reference which was a study in England, at time of autopsy of Trauma patients demonstrating the 50-60% non-penetration of the 1 1/2 inch decomression needle....I'll find it sooner or later.
ss
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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swatsurgeon is offline
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11-30-2005, 09:16
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#24
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Quiet Professional
Join Date: Jan 2004
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Study - Longer needles needed for fatter buttocks
Funny you should mention that SS, the correlation between fat people and needles. I read this just yesterday.....
CHICAGO (Reuters) - Fatter rear ends are causing many drug injections to miss their mark, requiring longer needles to reach buttock muscle, researchers said on Monday.
Standard-sized needles failed to reach the buttock muscle in 23 out of 25 women whose rears were examined after what was supposed to be an intramuscular injection of a drug.
Two-thirds of the 50 patients in the study did not receive the full dosage of the drug, which instead lodged in the fat tissue of their buttocks, researchers from The Adelaide and Meath Hospital in Dublin said in a presentation to the annual meeting of the Radiological Society of North America.
Besides patients receiving less than the correct drug dosage, medications that remain lodged in fat can cause infection or irritation, researchers Victoria Chan said.
"There is no question that obesity is the underlying cause. We have identified a new problem related, in part, to the increasing amount of fat in patients' buttocks," Chan said.
"The amount of fat tissue overlying the muscles exceeds the length of the needles commonly used for these injections," she said.
The 25 men and 25 women studied at the Irish hospital ranged in age from 21 to 87.
The buttocks are a good place for intramuscular injections because there are relatively few major blood vessels, nerves and bones that can be damaged by a needle. Plentiful smaller blood vessels found in muscle carry the drug to the rest of the body, while fat tissue contains relatively few blood vessels.
Obesity affects more than 300 million people worldwide and is based on a measure of height versus weight that produces a body mass index above 30. An estimated 65 percent of U.S. adults are overweight or obese.
© Reuters 2005. All Rights Reserved.
http://today.reuters.com/news/newsar...CKS.xml&rpc=22
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Team Sergeant is offline
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11-30-2005, 09:39
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#25
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Auxiliary
Join Date: Jun 2004
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Quote:
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Originally Posted by swatsurgeon
your data was alittle flawed. The article you cited was from Acad Emerg Med, 2004, Feb:11;211-13. It stated a 5 cm needle would decompress 75% of all chests. Interestingly it also stated that females had a thicker chest wall....was this a civilian female or military??? With obesity so rampant here I can believe that fact if it was NON-military women. Otherwise the 5 cm should do it. We have seen "harpoons" used at other hospitals that have infact stuck into the heart and the lung and made matters worse not better...hence why 5 cm was the 'best alternative'.
I'm still looking for my original reference which was a study in England, at time of autopsy of Trauma patients demonstrating the 50-60% non-penetration of the 1 1/2 inch decomression needle....I'll find it sooner or later.
ss
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your right sorry, 5 cm will only do in 75%, i will sill go for 3in=7,5 cm, but agree no harpoons.
here is some some from my powerpoint on TCCC, it a small summary of the articel is use in the ppt. thay are civ i think, but traind chest will give problem too we had one bodybilder in the ICU, a will back we try to needl.
Needle thoracostomy: implications of computed tomography chest wall thickness.
111 computed tomography (CT) scans
The mean chest wall thickness in the patients studied averaged 4.24 cm (95% confidence interval [CI] = 3.97 to 4.52)
Nearly one fourth (25) of the study patients had a chest wall thicker than 5 cm.
Women, on average, have thicker chest walls than men (4.90 for women; 4.16 for men; p = 0.022).
CONCLUSIONS: In this study, a catheter length of 5 cm would reliably penetrate the pleural space of only 75% of patients. A longer catheter should be considered, especially in women
Givens ML, Ayotte K, Manifold C.
Acad Emerg Med. 2004 Feb;11(2):211-3.
Needle thoracocentesis in tension pneumothorax: insufficient cannula length and potential failure.
ultrasound in 54 patients aged 18 to 55 years, and ranged from 1.3 to 5.2 cm (mean 3.2 cm).
In thirty-one patients (57 per cent) the chest-wall thickness (CWT) was greater than 3 cm.
two (4 per cent) was it greater than 4.5 cm.
recommended shortest length be increased to 4.5 cm.
Unsuccessful needle thoracocentesis using a 4.5 cm cannula should be followed immediately by insertion of a longer cannula or a definitive chest drain.
Britten S, Palmer SH, Snow TM.
Injury. 1996 Jun;27(5):321-2.
__________________
If we are going to ask one of our combat medics to undertake a medical treatment in the middle of a firefight, then we need to be as sure as possible that the benefit resulting from this treatment is going to be worth the risk.
Last edited by 52bravo; 11-30-2005 at 09:51.
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11-30-2005, 09:58
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#26
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just have to say the reson for 3in is also that only can get my hand on needls in fix length.
a nother way is to do a am. "simpel Thoracotomy" it is use by HEMS in london. but you havt to be a MD.
__________________
If we are going to ask one of our combat medics to undertake a medical treatment in the middle of a firefight, then we need to be as sure as possible that the benefit resulting from this treatment is going to be worth the risk.
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52bravo is offline
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11-30-2005, 12:54
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#27
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Guerrilla Chief
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TS,
this just goes to show that the average american patient is very different than the average military personnel. Those who defend this county and fight for everything good are in no way todays "average" american.(in a lot of ways)...therefore we can assume and I'll see about proving this, that the military personel that would need a chest decompression would be well served by carrying a 5 (to 6cm) cm decompression needle. They are NOT obese or carrying so much chest wall muscle mass that this size needle won't penetrate >90% of the time. There remains a HUGE difference between civilian/EMS and military medicine...that is one of my main points...some similarity but a lot of difference.
I will be contacting associates at military hospitals and have them do a sample of chest CT scans for wall thickness.....this should be interesting!!
ss
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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swatsurgeon is offline
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12-24-2005, 01:48
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#28
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Asset
Join Date: Dec 2005
Location: PDRW (Lewis)
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Spot check.
Please excuse this pogue for sticking his nose in, but I have to raise a point which is important to the discussion. This is in no way meant to disparage anyone's imput in this discussion, it is merely to make a correction which could be important when the situation comes down to "brass tacks."
I keep seeing "5cm = 2 1/2 inches" which isn't correct.
There are exactly 2.54cm to an inch, hence 5cm is just shy of 2 inches, not 2 1/2 inches. 2 1/2 inches would actually be 6.35cm. The only way to stretch this measurement would be to include the bedding material of the needle and then some, and even being a non-medico pogue, this does not sound like it could possibly be correct. Of course, I would also presume that measurements in inches would be damn near non-existant with medical supplies, but then again, not my area.
I only bring this up because in this case the measurement is fairly important, and it could have bad consequences if someone has the wrong numbers engrained in their brains and is trying to make a misinformed "educated guess" as to what will be appropriate for a given patients makeup under stress.
Please forgive my intrusion.
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US Army "Cold War" Veteran
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12-24-2005, 08:09
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#29
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Guerrilla Chief
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Thank you for pointing out the measurement correction ...it is a 'generic' length that we use in the hospital. The actual catheter length is 57mm which is 2 1/4 inches long........I should have been specific...the 2 1/2 inch length is the needle that is removed when the 2 1/4 inch catheter is in place....
thanks...
ss
__________________
'Revel in action, translate perceptions into instant judgements, and these into actions that are irrevocable, monumentous and dreadful - all this with lightning speed, in conditions of great stress and in an environment of high tension:what is expected of "us" is the impossible, yet we deliver just that.
(adapted from: Sherwin B. Nuland, MD, surgeon and author: The Wisdom of the Body, 1997 )
Education is the anti-ignorance we all need to better treat our patients. ss, 2008.
The blade is so sharp that the incision is perfect. They don't realize they've been cut until they're out of the fight: A Surgeon Warrior. I use a knife to defend life and to save it. ss (aka traumadoc)
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