thoracocentesis isn't performed in the second intercostal space at the midclavicular line anymore. It is now recommended to punction the thorax at the 5th intercostal space between the mid-axillary line and the anterior axillary line.
Incorrect. this is an emergency needle aspiration of a tension pneumothorax. "Needle thoracocentesis" was described as taught by American, Australian and European guidelines.
thanks for your response. You should check out ATLS`s procedure description at it's latest edition. It says, ipsis literis: Needle Decompression "For adults (especially with thicker subcutaneous tissue), use the fourth or fifth intercostal space anterior to the midaxillary line"@@amitpatel86
It's continued in part 2 from where this part leaves off. RUclips is showing an inaccurate duration, possibly left over in the original video file from when the original recording was split into 2 parts.
I'm coming from a TCCC background. Why don't they check the back for injuries under B? There's always the possibility of penetrating injuries and open pneumothorax.
this is good but we should assess neck before placing cervical collar, lookng for jugular vein distention, Tracheal deviation and cervical step off. then C collar should be applied
Hello, Is not thoracocentesis done for fluid in the pleural cavity. Why does the student keep referring needle thoracostomy as thoracocentesis?Are they same?( I am medical student) Thanks in advance.
1.After the needle decompression of chest is there any role of under water seal of cannula ? 2.When trachea is midline .It is just pneumothorax right ?why tension pneumothorax?
Hi Harish, 1. Emergency needle thoracocentesis is only a temporary procedure. After it has relieved the pressure you need to place a definitive drain (if indeed there was a tension pnuemothorax). This requires insertion of a chest drain, which is attached to an underwater seal as are all chest drains. See www.oxfordmedicaleducation.com/clinical-skills/procedures/intercostal-drain/ for details. 2. A tension pneumothorax is any pneumothorax where a pathological one-way valve leads to positive pleural pressure and subsequent venous compression with haemodynamic compromise. This MAY lead to tracheal deviation but you can have significant tension pneumothorax without tracheal deviation. Having said that, in trauma patients with tracheal deviation, respiratory and haemodynamic compromise, tension pneumothorax should always be top of your list. Hope this helps.
Thank you so much. If a patient is having pneumothroax with hyper resonant sounds with no obvious breathlessness & stable vitals with high hyperresonant sounds .Can we directly go for ICD than needle decompression ?
Absolutely. If a pneumothorax is suspected clinically but there is no immediate compromise then no need to do needle decompression; you have some time. Get a CXR to confirm pneumothorax, followed by formal ICD. For usual pneumothorax management see guidelines on www.oxfordmedicaleducation.com/emergency-medicine/pneumothorax/
IF he was brought in by paramedics, his c spine would already be immobilised and if he was unresponsive in a high mechanism trauma he would already be RSI by HEMS to protect airway and the pre alert call should mean there is already an anaesthetist waiting in the trauma bay or en route to.. This scenario is not at all realistic..
What was done was needle decompression, just a temporary management of tension pneumothorax. The definitive one which is a tube thoracostomy, should be connected to an under water seal
Brilliant! I love how there is someone letting the student know what he's finding on the patient.
indeed. this video is really nice
This is a training video. Clearly in practice the speed and order may differ but the structure of this ATLS-based system ensures nothing is missed.
thoracocentesis isn't performed in the second intercostal space at the midclavicular line anymore. It is now recommended to punction the thorax at the 5th intercostal space between the mid-axillary line and the anterior axillary line.
Incorrect. this is an emergency needle aspiration of a tension pneumothorax. "Needle thoracocentesis" was described as taught by American, Australian and European guidelines.
thanks for your response. You should check out ATLS`s procedure description at it's latest edition. It says, ipsis literis: Needle Decompression "For adults (especially with
thicker subcutaneous tissue), use the fourth
or fifth intercostal space anterior to the
midaxillary line"@@amitpatel86
Hey i just watch this video and i agree with you
But i have to say that this video was being publicated 10 years ago so during that times what he did is based on the procedure.
@@paska_lia4340 EXTRACTLY
As an American, this is quite entertaining to watch.
6:01 what a nice nurse.
This is more than excellent 👏🏻👏🏻 😊 thanks a lot it was very helpful
Excuse-me Sir, I believe there is a problem with this video.It`s stop working at 06:37.What`s happening?
It's continued in part 2 from where this part leaves off. RUclips is showing an inaccurate duration, possibly left over in the original video file from when the original recording was split into 2 parts.
I'm coming from a TCCC background. Why don't they check the back for injuries under B? There's always the possibility of penetrating injuries and open pneumothorax.
really nice video , excellent
this is good movie for all doctors. we lear about all trauma case. thanks for shearing
3:43 Great gloves.
Hahaha
this is good but we should assess neck before placing cervical collar, lookng for jugular vein distention, Tracheal deviation and cervical step off. then C collar should be applied
Man! This is how OSCE should be😮
Hello,
Is not thoracocentesis done for fluid in the pleural cavity. Why does the student keep referring needle thoracostomy as thoracocentesis?Are they same?( I am medical student)
Thanks in advance.
Both terms are interchangeable. thoraco (thorax) centesis (puncture for aspiration). refer to ruclips.net/video/sJ5eCDEcyKI/видео.html.
great video, thanks!
on neck inspection must say about the neck veins distended or flat and for pneumothorax you will have tachycardia
Is that JOhn McMaster speaking?
I wonder how much would be dropped from this for a field assessment and treatment.
Especially this many years later how much has changed.
1.After the needle decompression of chest is there any role of under water seal of cannula ?
2.When trachea is midline .It is just pneumothorax right ?why tension pneumothorax?
Hi Harish,
1. Emergency needle thoracocentesis is only a temporary procedure. After it has relieved the pressure you need to place a definitive drain (if indeed there was a tension pnuemothorax). This requires insertion of a chest drain, which is attached to an underwater seal as are all chest drains.
See www.oxfordmedicaleducation.com/clinical-skills/procedures/intercostal-drain/ for details.
2. A tension pneumothorax is any pneumothorax where a pathological one-way valve leads to positive pleural pressure and subsequent venous compression with haemodynamic compromise. This MAY lead to tracheal deviation but you can have significant tension pneumothorax without tracheal deviation. Having said that, in trauma patients with tracheal deviation, respiratory and haemodynamic compromise, tension pneumothorax should always be top of your list.
Hope this helps.
Thank you so much.
If a patient is having pneumothroax with hyper resonant sounds with no obvious breathlessness & stable vitals with high hyperresonant sounds .Can we directly go for ICD than needle decompression ?
Absolutely. If a pneumothorax is suspected clinically but there is no immediate compromise then no need to do needle decompression; you have some time. Get a CXR to confirm pneumothorax, followed by formal ICD.
For usual pneumothorax management see guidelines on www.oxfordmedicaleducation.com/emergency-medicine/pneumothorax/
Perfect for my finals
Well done!
What does he say at 6:01?
“Could you prepare the chest drain kit for me”
IF he was brought in by paramedics, his c spine would already be immobilised and if he was unresponsive in a high mechanism trauma he would already be RSI by HEMS to protect airway and the pre alert call should mean there is already an anaesthetist waiting in the trauma bay or en route to.. This scenario is not at all realistic..
This is exam practice, this simulates the exam setting quite well
great job
You have to connect the needle thoracostomy to an underwater seal, isn't it 🤔?
What was done was needle decompression, just a temporary management of tension pneumothorax.
The definitive one which is a tube thoracostomy, should be connected to an under water seal
seriously? i think its a bit different than ATLS procedure right?
tape secured with precision....meanwhile, pt arrests from hypovolemic shock/pericardial tamponade
yes,i thought the same thing too
What is a neethist?
Anestesiologist
@@yurineri2227 for an airway? An ED doc can intubate no problem. A paramedic can intubate no problem. Seems silly to call for a specialist.
is this for an MD student?
Needle decompression
No circulation
I think the neck braces are being slowly taken out of service aren't they?
3:47 bro is sensitized
My teacher recommended for watch this video that’s I m here
But good
Thanks a lot
Excuse me doctor ..your glove is broken😅
But in the real situation the nurse will do all of this
Nano machines son, they harden in response to physical trauma.
Too slow
Very nice. My best wishes for you to be a muslim.
Wtf
wtf...