Dr. Peter Antevy explains needle decompression for pediatric tension pneumothorax. A 2019 study of over 240 children found a 14-gauge, 1.25-inch needle works for kids, shorter than the adult standard. Insert at the 5th intercostal space, mid-axillary line, only if the child has respiratory distress, diminished breath sounds on one side, and age-appropriate hypotension.
Questions this video answers
Prehospital Emergency Care, February 2019, group from Colorado Children’s Hospital (measured chest wall thickness by CT in >240 children).
14-gauge, approximately 1.25-inch (1 1/4 inch) needle.
5th intercostal space, mid-axillary line.
1) Respiratory distress or inability to bag effectively; 2) Diminished breath sounds on the affected side; 3) Age-appropriate hypotension (protocol references systolic <90 mmHg as adult threshold; use pediatric age-appropriate values from app/book).
Chapters
Hey everyone, this is Dr. Entebbe. I wanted to talk today about chest trauma. It's not a topic we talk about often in pediatric patients, but I wanted to talk about some brand new data that has caused us to change our protocol. And I wanted to show you the needles that we're going to be discussing. We'll talk about the protocol and the actual location of where these needles go. But let's talk about tension pneumothorax. Whether it be adult or pediatrics, it's the same protocol, the chest trauma protocol. There's a study that just came out that you're seeing on the screen right here. This is from February 2019, pre hospital emergency care by the folks out of Colorado Children's Hospital. And what they did, they measured by CAT scan the chest wall thickness of over 240 children. And they measured exactly how thick is that chest wall from the skin all the way down into the pleural space. And what they've, what they recognize is that the only needle size you need to get through that is something here that we have here, which is about one and a quarter inch. And so you can see here, we've now purchased the 14 gauge. But now instead of having a three and a quarter inch, let's say on a one year old, on a five year old, now you just have one and a quarter inch. So it's a two full inches shorter. And you can see here that this will have less opportunity to kink and this would be better for the pediatric patient. So what I want you to know is look for this particular item, recognize that it's the same location, fifth intercostal space, mid axillary line as you would for the adult. But just recognize here that we're using a new needle rather than the adult needle that we have for the adult tension pneumothorax. So let's talk about the protocol for tension pneumo. You need three of the following, not one or the other, but all three of them. So respiratory distress or the inability to bag effectively is number one. The second thing is diminished breath sounds on the affected side. And the third one is age appropriate hypotension. So the protocol says a blood pressure of less than 90, but of course for pediatrics that systolic blood pressure is age appropriate. And you can find that in the app or in the book.
Okay, so just to finalize everything, as you know, we've worked really hard to have the adult and pediatric protocol be as one. I want you to think of these patients, whether child or pediatric as the same. So if you're running on a call of a three year old who was ejected from a vehicle on the turnpike and you come in and you see respiratory distress, diminished breath sounds, hypotension, I don't want you to think twice. I want you to take that needle and I want you to insert it in the appropriate location. We want to treat kids just like we treat adults. And that's why the protocol is as that. You guys are amazing, you guys do amazing work and I wanted to thank you very much. Have a great day.
