EMCrit Podcast Podcast 62 – Needle vs. Knife II: Needle Thoracostomy?
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Dec 12, 2011 The discussion delves into the effectiveness of needle compression in emergency scenarios. Key arguments highlight difficulties in targeting, issues with angiocath reach, and potential misdiagnosis leading to complications. It also emphasizes the case for finger thoracostomy over needle thoracostomy, showcasing its advantages in treating pneumothorax in urgent situations. Engaging scenarios illustrate why precision and technique are critical in trauma care.
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Needle Decompression Has Critical Flaws
- Needle decompression often fails due to inability to locate the correct anterior intercostal space and insufficient needle length.
- Incorrect anterior insertion risks injuring vital structures, making lateral approaches safer and more reliable.
Use Lateral Longer Needle
- Prefer lateral needle thoracostomy at the 4th or 5th intercostal space in the mid-axillary line for safety and familiarity.
- Use a longer catheter than the standard 1 to 1.5 inch angiocath, ideally a long 18 or 14 gauge, to ensure pleural space penetration.
Choose Finger Thoracostomy Quickly
- For a patient with confirmed tension pneumothorax in the trauma bay, perform a rapid finger thoracostomy instead of needle decompression.
- Use a small Kelly clamp or curved hemostat to puncture and spread muscles quickly, then insert your finger to release air.