First Aid Kit ----- Iain Smith

Needle thoracocentesis (sticking a large bore needle through the chest wall)
is the only effective treatment for a tension pneumothorax, which is why I
carry a suitable needle in my dive bag. Now, if it's me that needs it doing,
I just hope there's another medic on the boat (or that one of my regular
buddies remembers what I taught them).

Iain

I did not want to hijack the stoney cove thread out of respect.

Iain your fist aid kit must be more comprehensive than mine ( have NO
medical training other that rescue course)
what do you carry ? is there a list somewhere.

out of curiosity how big is this needle then.

Regards David

"david" <im@fedup.com> wrote ...

> Iain
>
> I did not want to hijack the stoney cove thread out of respect.
>
> Iain your fist aid kit must be more comprehensive than mine ( have NO
> medical training other that rescue course)
> what do you carry ? is there a list somewhere.
>
> out of curiosity how big is this needle then.

Errr... David... I don't think that I want to know in advance just what
/Dr./ Iain Smith carries in his first aid box just in case he decides to use
it on me

K

> Errr... David... I don't think that I want to know in advance just what
> /Dr./ Iain Smith carries in his first aid box just in case he decides to
use
> it on me



I do have a first aid kit but I just wondered what a trained medical type
person
carried. when I met my girlfriend 10 years ago i new we would get on when
she showed me
her tool box.( nothing crude please).

David

> Iain your fist aid kit must be more comprehensive than mine
> ( have NO medical training other that rescue course)
> what do you carry ? is there a list somewhere.

Not a lot more, actually. Our club trips always have our club first aid kit
and O2 set (as per BSAC First Aid for Divers and O2 Admin course
recommendations) although I recently added a non-rebreathing mask to the O2
kit (allows delivery of free-flow oxygen to a breathing casualty at about
85-90% if the demand valve (100%) is already in use)

I tend to carry some simple oropharyngeal airways (as taught on the BSAC
Rescue First Aid course) and I keep meaning to buy my own bag-and-mask
resuscitator (also taught on RFA) but have never quite got round to it.

And, of course, the cannula, which is the only one of the above items that
enables me to do something that someone with oxygen administration and basic
first aid training can't do at all (as opposed to being able to do some
things better, eg airway maintenance and ventilation)

FWIW, one thing I like to demonstrate when teaching oxygen administration is
that you can deliver a lot more oxygen to a non-breathing casualty by having
the rescuer breath from the demand mask than you can by using a typical
"oxygen-enriched AV" setup (where you're doing standard AV with a free-flow
O2 pocket mask.)

> out of curiosity how big is this needle then.

It's a 14G cannula. What this means is that it's the (large) type of needle
one normally gives fluid through. The metal pointy bit is just over 1mm wide
and is 45mm long.

As Keith pointed out, yes, I am a doctor. Some on here may remember a chap
called Paul Thomas who, at one point, suggested that we should teach people
how to deal with tension pneumothoraces as part of either O2 Admin or RFA. I
confess that I'm coming round to his point of view...

Iain

"Iain Smith" <iainmsmith@btinternet.com> wrote in message
news:Pd6%b.944$6l4.188@newsfe1-win...
> > Iain your fist aid kit must be more comprehensive than mine
> > ( have NO medical training other that rescue course)
> > what do you carry ? is there a list somewhere.
>
> Not a lot more, actually. Our club trips always have our club first aid
kit
> and O2 set (as per BSAC First Aid for Divers and O2 Admin course
> recommendations) although I recently added a non-rebreathing mask to the
O2
> kit (allows delivery of free-flow oxygen to a breathing casualty at about
> 85-90% if the demand valve (100%) is already in use)
>
> I tend to carry some simple oropharyngeal airways (as taught on the BSAC
> Rescue First Aid course) and I keep meaning to buy my own bag-and-mask
> resuscitator (also taught on RFA) but have never quite got round to it.
>
> And, of course, the cannula, which is the only one of the above items that
> enables me to do something that someone with oxygen administration and
basic
> first aid training can't do at all (as opposed to being able to do some
> things better, eg airway maintenance and ventilation)
>
> FWIW, one thing I like to demonstrate when teaching oxygen administration
is
> that you can deliver a lot more oxygen to a non-breathing casualty by
having
> the rescuer breath from the demand mask than you can by using a typical
> "oxygen-enriched AV" setup (where you're doing standard AV with a
free-flow
> O2 pocket mask.)
>
> > out of curiosity how big is this needle then.
>
> It's a 14G cannula. What this means is that it's the (large) type of
needle
> one normally gives fluid through. The metal pointy bit is just over 1mm
wide
> and is 45mm long.
>
> As Keith pointed out, yes, I am a doctor. Some on here may remember a chap
> called Paul Thomas who, at one point, suggested that we should teach
people
> how to deal with tension pneumothoraces as part of either O2 Admin or RFA.
I
> confess that I'm coming round to his point of view...
>
> Iain
>
Well I hope I never see that needle comming my way sounds painfull but meybe
I would be
a little under the weather if that needle was pointing at me

thanks for reply

David

Iain Smith wrote:
> As Keith pointed out, yes, I am a doctor. Some on here may remember a chap
> called Paul Thomas who, at one point, suggested that we should teach people
> how to deal with tension pneumothoraces as part of either O2 Admin or RFA. I
> confess that I'm coming round to his point of view...

I think the main problem would be trying to teach peole _when_ to do it
rather than how to do it. It wouldn't be very good if they went round and
randomly stuck a big pointly think into every DCI casulty...

Al.

> > As Keith pointed out, yes, I am a doctor. Some on here may
> > remember a chap called Paul Thomas who, at one point,
> > suggested that we should teach people how to deal with
> > tension pneumothoraces as part of either O2 Admin or RFA. I
> > confess that I'm coming round to his point of view...
>
> I think the main problem would be trying to teach peole
> _when_ to do it rather than how to do it. It wouldn't be very
> good if they went round and randomly stuck a big pointly
> think into every DCI casulty...



Agreed. Having spent most of this evening discussing this at my club night,
I'm coming to the conclusion that it would have to be on a protocol along
the lines of:

[NB: The following is purely for discussion and should not be taken as a
protocol by which a non-medically trained person should attempt to diagnose
a tension pneumothorax and particularly should not be used to make a
decision as to whether to attempt decompression of a tension pneumothorax]

History:
Has the casualty had a rapid/breath-holding ascent? (ie could they have
burst a lung?)
Did they have chest pain on arrival at the surface?
Is there blood stained spittle? (Not necessarily present, but suspicious)

Examination:
(given that using a stethoscope isn't really an option on a dive boat and
percussion isn't hugely reliable if done by someone inexperienced)

Are the casualty in obvious respiratory distress?
(Breathing rapid and shallow)
Is one side of the chest moving more than the other?

Has the casualty got a very weak/absent pulse?
(A Tension Pneumo will reduce BP)
Has the casualty got distended neck veins?
(?ability of non-medic to identify these)

Has the trachea deviated?
(Very late sign, by which stage the casualty really, really needs something
doing! I also can't think of any other diving situation in which the trachea
would deviate unless someone had pre-existing deviation...which is pretty
rare and would normally suggest some other pathology severe enough to
prevent diving in the first place.)

Possibly also: Is the casualty cyanosed? Has the casualty become
unconscious?

If the above conditions are met, decompress the side of the chest that is
moving less and from which the trachea has deviated AWAY.

In other words, make the diagnosis virtually bomb-proof and limit the use of
the technique to the extreme situation.

Iain

Iain Smith wrote:
> The following is purely for discussion and should not be taken as a
> protocol by which a non-medically trained person should attempt to
> diagnose a tension pneumothorax and particularly should not be used to
> make a decision as to whether to attempt decompression of a tension
> pneumothorax

Which is of course another point, I'm sure there would be (lots of?) legal
implications about arming people with the kit to do this and "certifing"
them...

> Has the casualty got a very weak/absent pulse?

I was under the impression that measuring the pulse "in the field" for
non-medics wasn't recommended these days as its been proved to be very
unreliable (which is why we're no longer supposed to stop and check for
a pulse while doing CC and AV).

Al.

"david" <im@fedup.com> wrote in message
news:c1itef$8kp$1@titan.btinternet.com...
>
> "Iain Smith" <iainmsmith@btinternet.com> wrote in message
> news:Pd6%b.944$6l4.188@newsfe1-win...
> > > Iain your fist aid kit must be more comprehensive than mine
> > > ( have NO medical training other that rescue course)
> > > what do you carry ? is there a list somewhere.
> >
> > Not a lot more, actually. Our club trips always have our club first aid
> kit
> > and O2 set (as per BSAC First Aid for Divers and O2 Admin course
> > recommendations) although I recently added a non-rebreathing mask to the
> O2
> > kit (allows delivery of free-flow oxygen to a breathing casualty at
about
> > 85-90% if the demand valve (100%) is already in use)
> >
> > I tend to carry some simple oropharyngeal airways (as taught on the BSAC
> > Rescue First Aid course) and I keep meaning to buy my own bag-and-mask
> > resuscitator (also taught on RFA) but have never quite got round to it.
> >
> > And, of course, the cannula, which is the only one of the above items
that
> > enables me to do something that someone with oxygen administration and
> basic
> > first aid training can't do at all (as opposed to being able to do some
> > things better, eg airway maintenance and ventilation)
> >
> > FWIW, one thing I like to demonstrate when teaching oxygen
administration
> is
> > that you can deliver a lot more oxygen to a non-breathing casualty by
> having
> > the rescuer breath from the demand mask than you can by using a typical
> > "oxygen-enriched AV" setup (where you're doing standard AV with a
> free-flow
> > O2 pocket mask.)
> >
> > > out of curiosity how big is this needle then.
> >
> > It's a 14G cannula. What this means is that it's the (large) type of
> needle
> > one normally gives fluid through. The metal pointy bit is just over 1mm
> wide
> > and is 45mm long.
> >
> > As Keith pointed out, yes, I am a doctor. Some on here may remember a
chap
> > called Paul Thomas who, at one point, suggested that we should teach
> people
> > how to deal with tension pneumothoraces as part of either O2 Admin or
RFA.
> I
> > confess that I'm coming round to his point of view...
> >
> > Iain
> >
> Well I hope I never see that needle comming my way sounds painfull but
meybe
> I would be
> a little under the weather if that needle was pointing at me
>
> thanks for reply
>
> David
>
>

it's not as big as the needles I have used... But then I was using them on
big bulls :)
you don't have time to find a vein and slowly press it in... You jab
randomly and squeeze the trigger before the bull is quite airborne :)

> Which is of course another point, I'm sure there would be
> (lots of?) legal implications about arming people with the
> kit to do this and "certifing" them...

Quite. Hence my "FFS don't do it!". If one were to introduce this as a
diving first aid skill, there would have to be lots of discussion with lots
of people to ensure that whatever protocol was implemented was robust enough
to keep the blood sucking ambulance-chasing land sharks at bay.

> > Has the casualty got a very weak/absent pulse?
>
> I was under the impression that measuring the pulse "in the
> field" for non-medics wasn't recommended these days as its
> been proved to be very unreliable (which is why we're no
> longer supposed to stop and check for a pulse while doing CC
> and AV).

You're thinking of the situation where you have a non-breathing casualty. If
someone is still conscious they _must_ have a pulse to find. If someone is
still breathing, they _must_ have a pulse to find. Its when the breathing
stops that you don't know whether they still have a pulse...

Add cold hands, inexperience, etc. into the equation and it becomes more
difficult. Is it something one must think of if considering a tension
pneumothorax? Not necessarily, but it's another useful clinical sign
consistent with such an event.

If all else fails, stick your ear to their chest - if it's reasonable quiet
("TURN THOSE F'ING ENGINES OFF FOR A MOMENT!!!") you should be able to hear
the heart beating which, if nothing else, will tell you how rapidly it's
going.

The point is, if someone has a tension pneumothorax, they're going to die in
a very few minutes. Anything you do wrong will not speed their demise. Doing
the right thing could save their life. It's how one gives people the ability
to do it that I haven't quite worked out yet!

Iain