Does needle thoracostomy provide adequate and effective decompression of tension pneumothorax?

Martin, Matthew J.; Satterly, Steven; Inaba, Kenji; Blair, Kelly

doi:10.1097/ta.0b013e31825ac511

Cited by 81 publications

(44 citation statements)

References 23 publications

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“…However, depending on the needle or cannula used, this is often ineffective at relieving the tension, as the needle may not be long enough to reach the pleural space, and it may dislodge or kink, rendering it useless, potentially allowing the tension pneumothorax to recur. 16,17 Thoracostomy is therefore recommended over needle decompression. [18][19][20] Thoracostomy is achieved by making a skin incision followed by blunt dissection with forceps or finger through the intercostal muscles and pleura in the same location that an intercostal drain is usually placed (fourth or fifth intercostal space, in the mid-axillary line).…”

Section: Management Of Reversible Causesmentioning

confidence: 99%

Traumatic cardiac arrest

2015

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Traumatic cardiac arrest is known to have a poor outcome, and some authors have stated that attempted resuscitation from traumatic cardiac arrest is futile. However, advances in damage control resuscitation and understanding of the differences in pathophysiology of traumatic cardiac arrest compared to medical cardiac arrest have led to unexpected survivors. Recently published data have suggested that outcome from traumatic cardiac arrest is no worse than that for medical causes of cardiac arrest, and in some groups may be better. This review highlights key areas of difference between traumatic cardiac arrest and medical cardiac arrest, and outlines a strategy for the management of patients in traumatic cardiac arrest. Standard Advanced Life Support algorithms should not be used for patients in traumatic cardiac arrest.

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Section: Management Of Reversible Causesmentioning

confidence: 99%

Traumatic cardiac arrest

2015

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“…Cadaver [47], animal [48][49][50], and clinical [51][52][53][54] studies have suggested that use of a small (3.2 cm) needle in the standard site (second intercostal space, midclavicular line) is not reliable, likely due to the thickness of the chest wall at this site and the small size of the needle or catheter. Even when proper placement is confirmed laparoscopically in animal models, Martin and colleagues showed that a 14-gauge angiocatheter fails to relieve tension physiology 64 % of the time [48]. The fourth or fifth intercostal space at the anterior axillary line is consistently thinner than the traditional site in multiple radiographic studies [52][53][54], which suggests that it may be a superior site for needle thoracostomy.…”

Section: Tension Pneumothoraxmentioning

confidence: 99%

Penetrating Injuries to the Lung and Heart: Resuscitation, Diagnosis, and Operative Indications

Scott

Sava

2015

Curr Trauma Rep

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Penetrating injuries to the thorax have the potential to disrupt two vital life-sustaining systems: the respiratory and the cardiovascular system. These injuries have the potential to be rapidly fatal and thus a rapid, organized, and logical approach to the evaluation and resuscitation of these patients is critical. This article briefly reviews the basic pathophysiology of penetrating chest wounds and the evaluation of both stable and unstable patients after penetrating chest injury. The recent literature is reviewed, including recent findings on screening for occult penetrating cardiac injuries, the use of needle decompression for pneumothoraces, and the expanding role of ultrasonography in the evaluation of penetrating thoracic trauma. Our goal is to review the initial management and resuscitation of patients with penetrating wounds to the thorax, with an eye toward the injuries most likely to rapidly result in death.

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“…Advanced Trauma Life Support (ninth edition) guideline suggests, "inserting a large-caliber needle into the second ICS in the MCL of the affected hemithorax" for the emergency management of tension pneumothorax [3]. Needle thoracostomy success rates vary by location, and its use has also been questioned in the literature [4][5][6]. Various needle lengths and locations were proposed and fifth intercostal space (ICS) emerged as the most popular alternative.…”

Section: Introductionmentioning

confidence: 99%