Friday, 28 May 2010


Needle Thoracocentesis.

Try saying that half way through your fourth night shift.

Worse still - try doing it when you've only had 10 hours sleep in the last four days.

And worst of all, despite being a paramedic for over four years - it's the first one you've ever done.

It's not the sort of skill that is either required or used very often. Even by trauma magnets such as yours truly. The problem is, that when you do need to use it, it's always deadly serious.

In the simplest terms, it involves sticking a large needle straight through the chest wall and into a collapsed lung. Counter-intuitively this will re-inflate the lung. Collapsed lungs (or pneumothorax in medicspeak) can be caused in various ways, such as severe asthma, sometimes spontaneously (especially in young, tall, fit people), and most commonly in ambulance terms by severe trauma. This can range from bad RTAs, to stabbings, shootings and other traumatic chest injuries.

The most dangerous sort, a tension pneumothorax, if left untreated, will kill. No questions. It will compress the lung, stop oxygen getting into the blood stream and round the body, and eventually compress the heart and stop that working too.

No oxygen + no heart = certain death.

It works, at the risk of telling fellow medics what they already know, a little as follows: the normal lung is a little like two balloons inflated one inside the other, with a tiny lubricated space in between, to make lung movements effective and painless.

In the case of a tension pneumothorax, the inner balloon has a leak. Every time you take a breath in, air enters the inner balloon. Normally, each time you breath out, the air leaves, but with a tension, the air moves from the inner balloon only as far as the outer balloon. That stretches, puts more pressure on the inner one, collapses it, and stops it working. It's also how the heart gets squashed, as well as eventually the other lung too. All in all, very nasty, and very, very deadly.

This is where the needle comes in. The needle goes into the large space that has now been created between the two balloons, lets out all the trapped air, allows the inner balloon to reinflate, releases the pressure on the heart, and allows the business of breathing to resume. It's only a very short-term solution, but gives the patient instant relief, and some vital extra time to get to hospital and definitive treatment.

In short - if you decompress the lung - you save a life.

Last night, for the first time ever, I stabbed someone in the chest.

Despite the 200 or so witnesses, and a police officer watching my every move, I got away with it.


Anonymous said...

Well done you! Legal stabbing, eh?

Next up? Needle cric...


-Ross- said...

Linked here by facebook. Makes life much easier now.

I bet that took a very steady hand!

Anonymous said...

The advantage of being a tech. I have spotted three so far and each time I have watched as the medic took a large gulp of air as it was their first.
Each time I have considered pointing out about the lack of spring in the arteries below the ribs.
This job can make you evil.

Rosie said...

I'm not a medic by any stretch of the imagination. This fascinates me.

Is it at all similar to a chest drain and is the patient put under if they are not already unconscious?

Fee said...

Yeek! In the patient's position, I'd rather be stabbed in the chest (by the right person) than dead.

Anonymous said...

Well done you!

Did the lung re-infalte, we keep on being told that it won't. I'm all confuzzed now???


stuart said...

An interesting way of looking at the anatomy of the lungs is thinking about shower curtains (give me a moment!)

You have Type II pneumocytes in the lungs, which produce a liquid called surfactant.

Now onto the shower curtain analogy - when dry, your shower curtain doesn't stick to the wall/bath, but when it's wet you get a seal forming which sticks the curtain to whatever flat surface it comes in contact with.

Surfactant acts in the same way - they stick the wall of your lung to the chest wall, and allow it to slide about without ripping etc.

Normally the lung will stay nicely attached to the wall, but when you introduce air into the gap it all goes to pot a bit!

Faking Patience said...

I loved your description of the lung, and how needle thoracocentesis works! It makes so much more sense to me now :)