Needle Decompression Complicated by Cardiac Injury in a Prehospital Environment.

Needle decompression is a mainstay intervention for tension pneumothorax in trauma medicine. It is used in combat and prehospital medicine when definitive measures are often not available or ideal. It can temporarily relieve increased intrathoracic pressure and treat a collapsed lung or great vessel obstruction. However, when done incorrectly, it can result in underlying visceral organ and vessel trauma. This is a case of an adult male who presented to the emergency department after sustaining multiple stab wounds during an altercation. On arrival, the patient had a 14-gauge angiocatheter inserted at the 4th intercostal space (ICS), left of the parasternal line traversing the right ventricle and interventricular septum and terminating in the left ventricle. The case emphasizes the importance of understanding the landmarks of performing needle decompression in increasing the procedure's efficacy and reducing iatrogenic complications.

A Novel, Perfused-Cadaver Simulation Model for Tourniquet Training in Military Medics.

BACKGROUND: Exsanguinating limb injury is a significant cause of preventable death on the battlefield and can be controlled with tourniquets. US Navy corpsmen rotating at the Navy Trauma Training Center receive instruction on tourniquets. We evaluated the effectiveness of traditional tourniquet instruction compared with a novel, perfused-cadaver, simulation model for tourniquet training. METHODS: Corpsmen volunteering to participate were randomly assigned to one of two tourniquet training arms. Traditional training (TT) consisted of lectures, videos, and practice sessions. Perfused-cadaver training (PCT) included TT plus training using a regionally perfused cadaver. Corpsmen were evaluated on their ability to achieve hemorrhage control with tourniquet(s) using the perfused cadaver. Outcomes included (1) time to control hemorrhage, (2) correct placement of tourniquet(s), and (3) volume of simulated blood loss. Participants were asked about confidence in understanding indications and skills for tourniquets. RESULTS: The 53 corpsmen enrolled in the study were randomly assigned as follows: 26 to the TT arm and 27 to the PCT arm. Corpsmen in the PCT group controlled bleeding with the first tourniquet more frequently (96% versus 83%; p < .03), were quicker to hemorrhage control (39 versus 45 seconds; p < .01), and lost less simulated blood (256mL versus 355mL; p < .01). There was a trend toward increased confidence in tourniquet application among all corpsmen. CONCLUSIONS: Using a perfused- cadaver training model, corpsmen placed tourniquets more rapidly and with less simulated-blood loss than their traditional training counterparts. They were more likely to control hemorrhage with first tourniquet placement and gain confidence in this procedure. Additional studies are indicated to identify components of effective simulation training for tourniquets.