Prehospital portable ultrasound for safe and accurate prehospital needle thoracostomy: a pilot educational study

Abstract

Background Simulated needle thoracostomy (NT) using ultrasound may reduce potential injury, increase accuracy, and be as rapid to perform as the traditional landmark technique following a brief educational session. Our objective was to determine if the use of an educational session demonstrating the use of handheld ultrasound to Emergency Medical Services (EMS) staff to facilitate NT was both feasible, and an effective way of increasing the safety and efficacy of this procedure for rural EMS providers. Methods A pre/post-educational intervention on a convenience sample of rural North American EMS paramedics and nurses. Measurement of location and estimated depth of placement of needle thoracostomy with traditional landmark technique was completed and then repeated using handheld ultrasound following a training session on thoracic ultrasound and correct placement of NT. Results A total of 30 EMS practitioners participated. Seven were female (23.3%). There was a higher frequency of dangerous structures underlying the chosen location with the landmark technique 9/60 (15%) compared to the ultrasound technique 1/60 (1.7%) (p = 0.08). Mean time-to-site-selection for the landmark technique was shorter than the ultrasound technique at 10.7 s (range 3.35–45 s) vs. 19.9 s (range 7.8–50 s), respectively (p < 0.001). There was a lower proportion of correct location selection for the landmark technique 40/60 (66.7%) when compared to the ultrasound technique 51/60 (85%) (p = 0.019). With ultrasound, there was less variance between the estimated and measured depth of the pleural space with a mean difference of 0.033 cm (range 0–0.5 cm) when ultrasound was used as compared to a mean difference of 1.0375 cm (range 0–6 cm) for the landmark technique (95% CI for the difference 0.73–1.27 cm; p < 0.001). Conclusions Teaching ultrasound NT was feasible in our cohort. While time-to-site-selection for ultrasound-guided NT took longer than the landmark technique, it increased safe and accurate simulated NT placement with fewer identified potential iatrogenic injuries.

Endpoints in Vital Signs as a Useful Tool for Measuring Successful Needle Decompression After Traumatic Tension Pneumothorax: An Analysis of the National Emergency Medicine Information System Database

“…Trauma is the leading cause of death in the United States for people under 44 years old [7]. In the setting of multisystem trauma, thoracic injuries such as pneumothoraces occur in 1-3% of major trauma and contribute to 60% of deaths [1,[7][8][9]. Pneumothorax occurs when air enters the potential space between the lung and the chest wall within the pleural cavity.…”

Empfehlungen zur Sonografieausbildung in der prähospitalen Notfallmedizin (pPOCUS): Konsensuspapier von DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI und DGIIN

“…Ebenso erleichtert sie potenziell die differenzierte Einleitung akutthe-rapeutischer Maßnahmen bereits am Einsatzort oder während des Transportes, z. B. die Entlastung eines Perikardergusses [16] oder eines Pneumothorax [17], die Differenzierung von Dyspnoe bedingt durch ein kardiales Lungenödem oder Pleuraergüsse bei Herzinsuffizienz. Hinsichtlich ihrer Durchführbarkeit und Effektivität ist die prähospitale Notfallsonografie mit derjenigen auf der Intensivstation vergleichbar [8], nimmt ggf.…”