Chest Decompression-When is it appropriate?

Chest Decompression-When is it appropriate?

The TEMS protocols state chest decompression with needle can be performed when the following occur:

  • Patient has hypotension (Systolic BP less than 90) 
  • With Clinical signs of shock and at least one of the following—
    • Jugular vein distention
    • Tracheal deviation away from the side of injury
    • Or Increased resistance when ventilating a patient

(Trauma patients in cardiac arrest with chest trauma may require bilateral needle decompression if indicated as well.)

“In the absence of clinical signs of shock, performing a needle decompression is inappropriate.”

You are encouraged to view the TEMS protocols here: http://tidewater.vaems.org/tidewater-ems-council/protocols/2013-protocols/1885-tems-protocol-full-size-guide-with-appendixes-2015-09-renaming

This means that your patient must be hypotensive (or pulseless) before you can consider a needle chest decompression.  If you have a patient that does not meet the criteria but you feel the procedure is warranted, you should contact medical control.

Please note that we have placed longer 14 G needles in the field with the RSI kits if you have a patient with more girth.  These needles are 3.25 inches so you may not need to insert it all the way to the hub in many patients.  Or if you have a smaller patient, stick to the 14 G angiocath in the IV box.  Other than being longer, there is no difference in the larger needle.