Podcast 541: Needle Thoracostomy

<p><strong>Author: Aaron Lessen, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Traditional technique of needle thoracostomy for tension penumothorax is along the 2nd intercostal space at the midclavicular line</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Inserting a large angiocatheter along the 4th or 5th intercostal space at the mid-axillary line may provide a thinner area that is more easily identified, overcoming many of the obstacles of the traditional approach</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">The 10th Edition of ATLS now recommends this location as well</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">A finger thoracostomy, where a scalpel and then the finger are used to penetrate the pleural cavity at the same location, is another method to provide quick decompression of a traumatic tension pneumothorax, allowing a tube thoracostomy to be performed later</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Laan DV, Vu TD, Thiels CA, et al. Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy.</span> <span style= "font-weight: 400;">Injury</span><span style="font-weight: 400;">. 2016;47(4):797–804. doi:10.1016/j.injury.2015.11.045</span></span></p> <p><span style="font-size: 10pt;">Inaba K, Branco BC, Eckstein M, Shatz DV, Martin MJ, Green DJ, Noguchi TT, Demetriades D.   Optimal positioning for emergent needle thoracostomy: a cadaver-based study. J Trauma. 2011 Nov;71(5):1099-103; discussion 1103. doi: 10.1097/TA.0b013e31822d9618.</span></p> <p><span style="font-size: 10pt;"><em><span style= "font-weight: 400;">Summarized and edited by Erik Verzemnieks, MD</span></em></span></p> <p><br /> <br /></p>