BET 2: Pre-hospital finger thoracostomy in patients with chest trauma

Pritchard, Jodie; Hogg, Kerstin

doi:10.1136/emermed-2017-206808.2

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…The combination of lower specificity in the absence of comet-tail artifact and lower sensitivity in the presence of lung points can be confusing. Finger thoracostomy is a widely accepted procedure which the surgeon creates an incision with a scalpel blade and a curved Kelly into pleural cavity to decompress fluid or air 13 . It must be very careful to prevent finger laceration especially when one patient has multiple rib fractures.…”

Section: Resultsmentioning

confidence: 99%

A novel optical technology based on 690 nm and 850 nm wavelengths to assist needle thoracostomy

Lee

Chuang

et al. 2021

Sci Rep

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The sensitivity of pneumothorax diagnosis via handheld ultrasound is low, and there is no equipment suitable for use with life-threatening tension pneumothorax in a prehospital setting. This study proposes a novel technology involving optical fibers and near-infrared spectroscopy to assist in needle thoracostomy decompression. The proposed system via the optical fibers emitted dual wavelengths of 690 and 850 nm, allowing distinction among different layers of tissue in vivo. The fundamental principle is the modified Beer–Lambert law (MBLL) which is the basis of near-infrared tissue spectroscopy. Changes in optical density corresponding to different wavelengths (690 and 850 nm) and hemoglobin parameters (levels of Hb and HbO2) were examined. The Kruskal–Wallis H test was used to compare the differences in parameter estimates among tissue layers; all p-values were < 0.001 relevant to 690 nm and 850 nm. In comparisons of Hb and HbO2 levels relative to those observed in the vein and artery, all p-values were also < 0.001. This study proposes a new optical probe to assist needle thoracostomy in a swine model. Different types of tissue can be identified by changes in optical density and hemoglobin parameters. The aid of the proposed system may yield fewer complications and a higher success rate in needle thoracostomy procedures.

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Section: Resultsmentioning

confidence: 99%

A novel optical technology based on 690 nm and 850 nm wavelengths to assist needle thoracostomy

Lee

Chuang

et al. 2021

Sci Rep

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“…Decompression can also be done by finger thoracostomy. 10 Surgery may be required to remove the retroserrated stinger.…”

Section: Discussionmentioning

confidence: 99%

“…9 When even improvised tools are unavailable, decompression can be performed by finger thoracostomy in the prehospital setting. 10 The case we describe highlights an improvised method consisting of decompression with a knife followed by insertion of a pen to serve as a chest tube. This modified prehospital intervention proved to be life-saving in this case and could potentially be so in future cases in remote settings with limited resources.…”

Section: Discussionmentioning

confidence: 99%

Whiptail Stingray Injury

Simon¹,

Martinet

Cuq³

et al. 2018

Wilderness & Environmental Medicine

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Stingray injuries to the chest are rare but potentially life-threatening. They may occur in remote areas where advanced emergency healthcare services are unavailable. We describe the case of a 24-year-old man with tension pneumothorax due to a Himantura fai stingray injury to the left chest. The chest wound was unremarkable, with no external bleeding or evidence of a foreign body. Decompression was performed at the scene with an improvised knife procedure and a hollow writing pen, which served as a chest tube. At the local hospital, a standard-sized chest tube was inserted, the wound cleaned, and the patient given antibiotics active against marine organisms. Computed tomography visualized the stinger and revealed hemopneumothorax and pneumomediastinum. The local hospital did not have a thoracic surgeon, and the patient was transferred to a larger hospital with a thoracic surgery center. After surgical removal of the stinger, segmental lung resection was required to control bleeding. Management of life-threatening stingray injuries to the chest should begin at the scene. After stabilization, the patient should be transferred to a hospital equipped for cardiovascular and thoracic surgery. Surgery may be required to remove the retroserrated stinger and can be challenging.

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“…A nyomáskiegyenlítésre vastag, hosszú tű, illetve mellűri drainage való. Különleges eset a már intubált beteg sürgősségi thoracostomája (prehospitalis fázis, sürgősségi scenario), bőrmetszés után tompán, akár ujjal [24]. Ideálisnak a tompa dissectiós (pl.…”

Section: Diagnózisunclassified

A pneumothoraxról: Szövetségesből ellenség •

Molnár

2023

MaSeb

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BevezetésMagyarországon évente 2000 fölötti számban kezelünk betegeket légmellel (pneumothorax: PTX). Az utolsó hazai irányelv 2008-ban járt le, ideje az újragondolásnak.MódszerA Brit Mellkasi Társaság és az Európai Légzési Társaság releváns útmutatásaira alapozva a legújabb nemzetközi és hazai szakirodalmi közlemények és a klinikai tapasztalat alapján tekintjük át a diagnosztika, a therapia kérdéseit, a kilátásokat.EredményekAlapvető különbség van a primaer és a secundaer spontán PTX esetén javallt döntésekben. Az előbbiben a műtét (VATS) preferálandó, amennyiben a drainage kezelés sikertelen, illetve recidivában, az utóbbiban jóval tartózkodóbbak lehetünk. A feszülő légmell az egyedüli valós életveszélyes állapot, mely haladéktalan detenzionálást követel. Egyébként a kezelési modalitások közüli választást a mechanizmus, a légzési tartalékok, a tüdő állapota, a beteg preferenciája és egyéb kockázati elemek határozzák meg. Az áthatoló traumás légmell és a punctiós iatrogen kezelési stratégiája a primaer légmellét követi, míg a fedett (zúzott, robbantott) eredetű a secundaer PTX-ét, mivel az expansiós hajlamot a tüdősérülés (contusio, consolidatio) mértéke szabja meg, hasonlóan a vírus okozta ARDS miatti lélegeztetés barotraumájához kapcsolódó PTX esetén. A katameniális légmell rendszerbetegség, a localis ellátást (sziget excisio, rekeszi felszín fedése) a hormonalis és a hasi/kismedencei status rendezése kíséri. Konklúzió: A tünetes, súlyos légzési zavart okozó légmell kezelési stratégiája nem változott, a többi formában óvatosabb, visszafogottabb a taktika. A nem intubalt mellkassebészet és a Covid–19-hez kapcsolódó ARDS-t kísérő légmell tapasztalatai finomították a legújabb felfogást.

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BET 2: Pre-hospital finger thoracostomy in patients with chest trauma

Cited by 5 publications

References 7 publications

A novel optical technology based on 690 nm and 850 nm wavelengths to assist needle thoracostomy

A novel optical technology based on 690 nm and 850 nm wavelengths to assist needle thoracostomy

Whiptail Stingray Injury

A pneumothoraxról: Szövetségesből ellenség •

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