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.