Needle Thoracostomy

Needle decompression of a pneumothorax is a time critical and life saving procedure. Classical teaching is to perform this in the 2nd ICS midclavicular line but is this the easiest and most effective place to perform it?

In this podcast I speak with Zaf Qasim, an EM physician in the US about the topic and the underpinning EBM. Below are some of the papers we’ll be discussing. Enjoy!

Simon
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http://www.ncbi.nlm.nih.gov/pubmed/26724173

But it’s probably a good idea to go back and have a look at some of the papers that make up this systematic review and some other literature on the topic

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http://www.ncbi.nlm.nih.gov/pubmed/14759970

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http://www.ncbi.nlm.nih.gov/pubmed/18274025

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http://www.ncbi.nlm.nih.gov/pubmed/22987168

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http://www.ncbi.nlm.nih.gov/pubmed/22071914

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http://www.ncbi.nlm.nih.gov/pubmed/18188107

So that brings us back to the systematic review 

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http://www.ncbi.nlm.nih.gov/pubmed/26724173

Is there a way to predict who we will struggle with? Can we accurately predict the need for a longer based needle for aspiration based on the patient’s appearance?

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http://www.ncbi.nlm.nih.gov/pubmed/24064394

So if we are thinking about changing practice it’s probably worth thinking about how well this could be implemented i.e. how likely is it that people are going to put the needle in the right position?

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http://www.ncbi.nlm.nih.gov/pubmed/16244336

Is it easier to identify one site compared to another?

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http://www.ncbi.nlm.nih.gov/pubmed/26488319

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http://www.ncbi.nlm.nih.gov/pubmed/8763284

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https://fphc.rcsed.ac.uk/media/1788/management-of-chest-injuries.pdf