Needle decompression of a tension pneumothorax if you must. I'd only advise this if you are actually trained. Although the insertion of a cath into the chest cavity of a non-existent pneumo don't have catastrophic side effects, a pneumo is hard to identify without the right training.
Except that you've just put a hole in somebody's chest that air can get into, pretty much creating a pneumo. Granted, you can occlude it, but I'd hate to be the person that has to explain THAT one. I do agree that, on the grand scheme of things, a 14g chest hole is fairly simple to close with some vaseline gauze, but I still don't think being dart-happy is a good approach.
You know, everybody talks about needle decompression and pneumothorax, but nobody mentions a stethoscope. I guess you can improvise, but I would think a GSW kit should have a steth in it. Why don't more people carry them? They aren't expensive compared to the bags people buy...
Came in here to say pretty much the exact same thing. I almost invariably have a BP cuff, too, in every kit I carry. It's great being able to treat things, but even better to have a good assessment to work off of.
I don't plan on sticking a needle into somebody without listening to their chest first, and I don't think anybody else should either. I also don't think mechanism of injury and inability to complete sentences w/o becoming short of breath is quite enough to clinically diagnose a tension pneumothorax. Clearly, if you suspect a tension pneumo and have a lot of experience recognizing them, that's one thing, but a lot of people here don't have that kind of experience. Maybe Murph does, I don't know, I'm not trying to insult anyone.
Determining factors for me, while I'm working, are decreased/absent breath sounds on one side, circulatory compromise (systolic blood pressure <100 mmHg, tachycardia, altered mental status, other obvious signs of shock), or deviated trachea (which is a very late sign, and sometimes doesn't happen) in the presence of
SOB, decreasing saturations, possible trauma etiology or obvious traumatic injury. I don't know about anybody else, but I feel that a needle thoracostomy is pretty invasive and much more of a "last ditch effort". YMMV, IANAD.
Nationally Registered Paramedic, Fire Lieutenant
Primum Non Nocere
Omnes ad Unum
The rest of you who aren't contributing anything, shut the fuck up and post in the chat thread if your life is really that lacking in fuckwittery.