Special Operations Forces Medical Handbook

8-13

2. Place your finger 0.5 cm below the costal margin of the patient’s xiphoid to mark the point of needle
   insertion. Raise the needle to a 30° angle from parallel to the patient’s chest. Aim the needle
   at the tip of the ipsilateral (same side) scapula (shoulder blade)


3. Insert the needle, maintaining slight suction and advanced until blood flow is obtained, and then
   stop advancement.


4. Withdraw as much a blood as possible and then withdraw the needle. Only a small amount (5-10
   cc) removed can have a marked improvement in vital signs.

Option B - Technique to Withdraw Fluid Multiple Times

1. Attach a central line needle and catheter to a 60 cc syringe.


2. Follow the procedure as above.


3. When fluid is obtained, hold the syringe and needle in one hand, and gently advance (slide) the
   catheter into the pericardial space. Withdraw the needle from the catheter.


4. Attach the 3-way stopcock (closed position) to the hub of the catheter


5. Remove the needle from the syringe and discard. Connect one end of IV tubing to one port of the
   3 way stopcock, the other end of the IV tubing attach to a 60 cc syringe (optional to connect
   another IV line to the third port of the stopcock for ejecting blood from the syringe).


6. Open the 3 way stopcock to the syringe to withdraw fluid from the pericardial space, then turn open
   to ejection port IV line to eject the fluid out.


7. When no further fluid/blood return, turn the 3-way stopcock to closed or in-between position.

Option C - Technique to Monitor Needle Approach with EKG Lead (use with both A & B above) to Withdraw
Fluid Multiple Times

1. Connect V1 lead of 12 lead EKG with an alligator clip to the metallic hub of the needle or needle
   stylet of the catheter, then insert needle as directed above.
   2. During the advancement of the needle, monitor the EKG for ST segment elevation. This indicates
   that the needle tip is in contact with myocardium and should be withdrawn.
   3. This monitoring improves the safety of the procedure, but is not practical in immediate life and
   death field scenarios.
   Post-Procedure:
   
   
   1. Monitor for pneumothorax and arrhythmias
   
   
   2. Collect samples of pericardial fluid in cases not related to penetrating trauma for later analysis.
   
   
   
   

What Not To Do:
Care must be taken not to insert the needle more than 1/8 of an inch once blood is obtained.
The catheter can be left in if the medic has a catheter line that can be switched between closed and open.
Remember, small movements of the syringe can have large effects on movement of the tip of the needle
causing lacerations of the myocardium or coronary arteries.

Procedure: Pneumatic Anti-Shock Garment

COL Clifford Cloonan, MC, USA

What: Apply pneumatic antishock garments

When: Otherwise uncontrollable, on-going hemorrhage in the lower abdomen/pelvis and/or buttocks/thigh(s);
neurogenic shock (especially when unable to avoid a head-up attitude, i.e. during extraction/ evacuation);
anaphylactic shock; pelvic fracture, femur/tibia fracture when traction splint not available (used as a pneumatic
splint).

What You Need: Pneumatic Anti-Shock Garment (a.k.a. – M.A.S.T.)

What To Do:

1. Apply the garment – there are various methods to do this (follow manufacturer recommendations/ATLS