More on needle thoracostomy for tension pneumothorax

Thanks to Dr. Matthew Oliver for highlighting these articles to me. The standard teaching of placing a handy iv catheter in the 2nd intercostal space, midclavicular line for tension pneumothorax has been challenged by previous studies suggesting about a third of adults have a chest wall that is too thick for a standard 4.5 to … Continue reading More on needle thoracostomy for tension pneumothorax

Inadequate pre-hospital needle thoracostomy

The purpose of this study was to evaluate the frequency of inadequate needle chest thoracostomy in the prehospital setting in trauma patients suspected of having a pneumothorax (PTX) on the basis of physical examination. This study took place at a level I trauma center. All trauma patients arriving via emergency medical services with a suspected … Continue reading Inadequate pre-hospital needle thoracostomy

Needle decompression: it's still not going to work

A pet topic that keeps coming up here is management of tension pneumothorax. Plenty of studies demonstrate that traditionally taught needle thoracostomy may fail, and open, or ‘finger’ thoracostomy is recommended for the emergency management of tension pneumothorax in a patient who is being ventilated with positive pressure (including those patients in cardiac arrest). A … Continue reading Needle decompression: it's still not going to work

Prehospital thoracostomy tube misplacement

An interesting study from Germany examined prehospital thoracostomy tube (TT) placement by physicians working in the field. Of 69 patients who received them, 67 underwent prehospital intubation. 88 TT were placed in the 69 patients. There were 19/88 (22%) radiologic chest tube misplacements (defined as too far in the chest, twisted, or bent). The position … Continue reading Prehospital thoracostomy tube misplacement

Open thoracostomy

Not a new paper to cite here, just a collection of resources that refer to open thoracostomy in trauma. A longstanding practice by some European and Australasian HEMS physicians, open thoracostomy is essentially a chest tube procedure without the actual intercostal catheter: the surgical incision is made, blunt dissection is performed, and the pleura penetrated. … Continue reading Open thoracostomy

Thoracostomy in blunt traumatic arrest

37 patients with blunt traumatic cardiac arrest underwent attempted resuscitation by a HEMS crew over a four year period. Chest decompression was performed in 18 cases (17 thoracostomy, one needle decompression). The procedure revealed evidence of chest injury in 10 cases (pneumothorax, haemothorax, massive air leak) and resulted in return of circulation and survival to … Continue reading Thoracostomy in blunt traumatic arrest

Chest needle too short

This CT study of 110 trauma patients showed: ‘the standard 4.4-cm angiocatheter is likely to be unsuccessful in 50% (95% confidence interval = 40.7–59.3%) of trauma patients on the basis of body habitus. In light of its low predicted success, the standard method for treatment of tension pneumothorax by prehospital personnel deserves further consideration’. Consistent … Continue reading Chest needle too short

Tension pneumo treatment and chest wall thickness

An interesting ultrasound-based study challenges the assertion that a significant proportion of adults have a chest wall that is too thick for a standard iv cannula to reach the pleural space when attempting to decompress a tension pneumothorax. Perhaps there are other factors that make this technique so frequently ineffective. The authors postulate that ultrasound … Continue reading Tension pneumo treatment and chest wall thickness

Tactical Combat Casualty Care

The brave men and women of the military not only risk their lives for us – they also provide a wealth of trauma experience and publish interesting stuff. This month’s Journal of Trauma contains a military trauma supplement. One of the articles describes the latest guidelines on Tactical Combat Casualty Care. These include: tourniquet use Quikclot … Continue reading Tactical Combat Casualty Care

Humeral Intraosseous – Stay In & Stay Straight

This video shows the mechanism for dislodgement and deformation of humeral intraosseous needles and how to avoid this. In summary, if you need to abduct the arm (eg. for thoracostomy), keep the thumbs down (ie. have the arm internally rotated at the shoulder). Otherwise the IO catheter may bend or fall out. References: 1. Pasley … Continue reading Humeral Intraosseous – Stay In & Stay Straight