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Pneumothorax needle decompression

Matthew L Leatherman, Jenny M Held, Laura M Fluke, Christian S McEvoy, Kenji Inaba, Daniel Grabo, Matthew J Martin, Angela S Earley, Robert L Ricca, Travis M Polk
BACKGROUND: Tension pneumothorax (tPTX) remains a significant cause of potentially preventable death in military and civilian settings. The current pre-hospital standard of care for tPTX is immediate decompression with a 14 gauge 8cm angiocatheter (14G AC); however, failure rates may be as high as 17-60%. Alternative devices, such as 10G AC, modified Veress needle (mVN) and laparoscopic trocar (LT), have shown to be potentially more effective in animal models; however, little is known about the relative insertional safety or mechanical stability during casualty movement...
April 5, 2017: Journal of Trauma and Acute Care Surgery
Benjamin Löser, Yuki B Werner, Mark A Punke, Bernd Saugel, Sebastian Haas, Daniel A Reuter, Oliver Mann, Anna Duprée, Guido Schachschal, Thomas Rösch, Martin Petzoldt
PURPOSE: Peroral endoscopic myotomy (POEM) is a novel technique for treating esophageal achalasia. During POEM, carbon dioxide (CO2) is insufflated to aid surgical dissection, but it may inadvertently track into surrounding tissues, causing systemic CO2 uptake and tension capnoperitoneum. This in turn may affect cardiorespiratory function. This study quantified these cardiorespiratory effects and treatment by hyperventilation and percutaneous abdominal needle decompression (PND). METHODS: One hundred and seventy-three consecutive patients who underwent POEM were included in this four-year retrospective study...
May 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Alexander Kaserer, Philipp Stein, Hans-Peter Simmen, Donat R Spahn, Valentin Neuhaus
INTRODUCTION: Chest decompression can be performed by different techniques, like needle thoracocentesis (NT), lateral thoracostomy (LT), or tube thoracostomy (TT). The aim of this study was to report the incidence of prehospital chest decompression and to analyse the effectiveness of these techniques. MATERIAL AND METHODS: In this retrospective case series study, all medical records of adult trauma patients undergoing prehospital chest decompression and admitted to the resuscitation area of a level-1 trauma center between 2009 and 2015 were reviewed and analysed...
November 30, 2016: American Journal of Emergency Medicine
H Drinhaus, T Annecke, J Hinkelbein
Decompression of the chest is a life-saving invasive procedure for tension pneumothorax, trauma-associated cardiopulmonary resuscitation or massive haematopneumothorax that every emergency physician or intensivist must master. Particularly in the preclinical setting, indication must be restricted to urgent cases, but in these cases chest decompression must be executed without delay, even in subpar circumstances. The methods available are needle decompression or thoracentesis via mini-thoracotomy with or without insertion of a chest tube in the midclavicular line of the 2nd/3rd intercostal space (Monaldi-position) or in the anterior to mid-axillary line of the 4th/5th intercostal space (Bülau-position)...
October 2016: Der Anaesthesist
Christine M Van Dillen, Matthew R Tice, Archita D Patel, David A Meurer, Joseph A Tyndall, Marie Carmelle Elie, Jonathan J Shuster
Introduction. Limited evidence is available on simulation training of prehospital care providers, specifically the use of tourniquets and needle decompression. This study focused on whether the confidence level of prehospital personnel performing these skills improved through simulation training. Methods. Prehospital personnel from Alachua County Fire Rescue were enrolled in the study over a 2- to 3-week period based on their availability. Two scenarios were presented to them: a motorcycle crash resulting in a leg amputation requiring a tourniquet and an intoxicated patient with a stab wound, who experienced tension pneumothorax requiring needle decompression...
2016: Emergency Medicine International
Jennifer Davies, David Spitzer, Maria Phylactou, Martin Glasser
A 91-year-old presented with a rare cause of cardiac arrest. He was initially admitted with severe back pain following vomiting and diagnosed with probable aspiration pneumonia. On day 3 of admission, he was discovered in cardiac arrest and cardiopulmonary resuscitation was started. On intubation, a left-sided pneumothorax and subcutaneous emphysema were noted. Needle decompression showed gastric fluid leaking from the cannula. The patient regained a cardiac output, and a subsequent CT scan confirmed a large pneumomediastinum with air tracking to the neck and chest, and bilateral pneumothoraces...
May 6, 2016: BMJ Case Reports
Matthias Hecker, Katrin Hegenscheid, Henry Völzke, Peter Hinz, Jörn Lange, Axel Ekkernkamp, Matthias Frank
BACKGROUND: Tension pneumothorax is one of the leading causes of preventable death in both military and civilian trauma patients. Needle decompression is recommended in trauma guidelines as an emergency procedure to relieve increased intrapleural pressure. The main reason for decompression failure is reported to be insufficient needle length in proportion to the chest wall thickness (CWT). So far, population-based epidemiologic data on CWT are missing. Therefore, it was the aim of this work to investigate the CWT in the second intercostal space, midclavicular line, based on magnetic resonance imaging data of a large population-based sample...
January 2016: Journal of Trauma and Acute Care Surgery
Shahzad Anjum, Ramsha Tahir, Sameer A Pathan
Nontuberculous mycobacterial infection in an immunocompetent young patient complicated with empyema and pneumothorax is rarely reported. A 36-year-old man presented to the emergency department with a history of worsening dyspnea and pleuritic chest pain. The patient had unstable vital signs on presentation, and was referred to the resuscitation area on a monitored bed. The patient had a chest x-ray (CXR) performed on a prior occasion at a primary health clinic, revealing pneumothorax and some fluid at the left costophrenic angle...
2015: Qatar Medical Journal
Kenji Inaba, Efstathios Karamanos, Dimitra Skiada, Daniel Grabo, Peter Hammer, Matthew Martin, Maura Sullivan, Marc Eckstein, Demetrios Demetriades
BACKGROUND: Computed tomographic and cadaveric studies have demonstrated needle decompression of tension pneumothorax at the fifth intercostal space (ICS), anterior axillary line (AAL) has advantages over the second ICS midclavicular line (MCL). The purpose of this study was to compare the ability of prehospital care providers to accurately decompress the chest at these two locations. METHODS: Randomly selected US Navy hospital corpsmen (n = 25) underwent a standardized training session followed by timed needle decompression on unmarked fresh cadavers...
December 2015: Journal of Trauma and Acute Care Surgery
Georgina Blenkinsop, Somayyeh Mossadegh, Mark Ballard, Paul Parker
Significant lessons to inform best practice in trauma care should be learned from the last decade of conflict in Afghanistan and Iraq. This study used radiological data collated in the UK Military Hospital in Camp Bastion, Afghanistan, to investigate the most appropriate device length for needle chest decompression of tension pneumothorax (TP). We reviewed the optimal length of device and site needed for needle decompression of a tension pneumothorax in a UK military population and found no significant difference between sites for needle chest decompression (NCD)...
2015: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Zarmina Ehsan, Jaimie D Nathan, Carolyn M Kercsmar
INTRODUCTION: We report an unusual finding of pneumatocele in an infant. CASE REPORT: A previously well four month old presented with worsening respiratory distress over 6 weeks. He had no antecedent signs or symptoms of respiratory infection. Chest radiograph demonstrated a lucent hemithorax concerning for tension pneumothorax. Urgent needle decompression was performed. Chest CT showed a persistent dominant macrocyst on the left. Thoracotomy revealed a large cystic lesion necessitating a left lower lobectomy...
December 2015: Pediatric Pulmonology
Jacob Chen, Roy Nadler, Dagan Schwartz, Homer Tien, Andrew P Cap, Elon Glassberg
BACKGROUND: Point of injury needle thoracostomy (NT) for tension pneumothorax is potentially lifesaving. Recent data raised concerns regarding the efficacy of conventional NT devices. Owing to these considerations, the Israeli Defense Forces Medical Corps (IDF-MC) recently introduced a longer, wider, more durable catheter for the performance of rapid chest decompression. The present series represents the IDF-MC experience with chest decompression by NT. METHODS: We reviewed the IDF trauma registry from January 1997 to October 2012 to identify all cases in which NT was attempted...
June 2015: Canadian Journal of Surgery. Journal Canadien de Chirurgie
V Kong, B Sartorius, D Clarke
INTRODUCTION: Traumatic tension pneumothorax (TPTX) is a life threatening condition, but literature describing this condition specifically in developing countries is scarce. MATERIALS AND METHODS: We conducted a retrospective review of 115 patients with a TPTX, managed over a 4-year period in a high volume trauma service in South Africa. RESULTS: A total of 118 TPTXs were identified in 115 patients. Eighty-nine percent (102/115) were males, and the mean age was 26 years (SD ± 6 years)...
February 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
P T Bach, C Sølling
This case report presents a young male admitted with primary bilateral spontaneous tension pneumothorax and severe respiratory distress. This is an extremely rare condition. The patient was on the verge of hypoxic cardiac arrest and the attempted needle thoracocentesis was unsuccessful. Needle thoracocentesis in the midclavicular line of the second intercostal space is widely used and recommended as first-line treatment of tension pneumothorax. Reviewing the literature, the procedure is not based on solid evidence...
July 2015: Acta Anaesthesiologica Scandinavica
Brian M Clemency, Christopher T Tanski, Michael Rosenberg, Paul R May, Joseph D Consiglio, Heather A Lindstrom
INTRODUCTION: Needle thoracostomy is the prehospital treatment for tension pneumothorax. Sufficient catheter length is necessary for procedural success. The authors of this study determined minimum catheter length needed for procedural success on a percentile basis. METHODS: A meta-analysis of existing studies was conducted. A Medline search was performed using the search terms: needle decompression, needle thoracentesis, chest decompression, pneumothorax decompression, needle thoracostomy, and tension pneumothorax...
June 2015: Prehospital and Disaster Medicine
Thomas Edrich, Cristina Pojer, Gerhard Fritsch, Joerg Hutter, Philip M Hartigan, Ottokar Stundner, Peter Gerner, Marc M Berger
A patient with an endobronchial tumor and critical airway obstruction developed hypoxia and hypercarbia and, subsequently, cardiac arrest during a palliative laser core-out excision. The differential diagnosis included tension pneumothorax, as well as airway obstruction due to swelling of residual tumor or to blood clots. In this case, empiric needle decompression could have had deleterious consequences. Immediate bedside lung ultrasonography provided real-time information leading to the stabilization of the patient...
March 15, 2015: A & A Case Reports
Juan F García-Regalado, Mariana M Navarro-Rojas
INTRODUCTION: Tension gastrothorax is caused by the herniation of the stomach into the thorax due to a congenital defect of the diaphragm; the Bochdaleck diaphragmatic hernia (HDB) is the most frequent type. OBJECTIVE: Tension gastrothorax should be considered as a differential diagnosis in patients with obstructive shock and tension pneumothorax. CASE REPORT: A previously healthy 10 month-old male infant, who presented increased respiratory distress, increased volume of the left hemithorax, absence of breath sounds, ipsilateral hyper-resonance, 76% saturation, cold skin and capillary filling > 5 seconds, followed by a cardio-respiratory arrest...
July 2014: Revista Chilena de Pediatría
Henri de Lesquen, Jean-Philippe Avaro, Lucile Gust, Robert Michael Ford, Fabien Beranger, Claudia Natale, Pierre-Mathieu Bonnet, Xavier-Benoît D'Journo
This review aims to answer the most common questions in routine surgical practice during the first 48 h of blunt chest trauma (BCT) management. Two authors identified relevant manuscripts published since January 1994 to January 2014. Using preferred reporting items for systematic reviews and meta-analyses statement, they focused on the surgical management of BCT, excluded both child and vascular injuries and selected 80 studies. Tension pneumothorax should be promptly diagnosed and treated by needle decompression closely followed with chest tube insertion (Grade D)...
March 2015: Interactive Cardiovascular and Thoracic Surgery
Malcolm J Boyle, Brett Williams, Simon Dousek
BACKGROUND: Tension pneumothorax (TPX) is an uncommon but life-threatening condition. It is important that this uncommon presentation, managed by needle decompression, is practised by paramedics using a range of educationally sound and realistic mannequins. The objective of this study is to identify if the chest wall thickness (CWT) of training mannequins used for chest decompression is an anatomically accurate representation of a human chest. METHODS: This is a two-part study...
2012: World Journal of Emergency Medicine
Stanislas Ledochowski, Grégory Axiotis, Florent Wallet, Arnaud Friggeri
No abstract text is available yet for this article.
November 2014: Intensive Care Medicine
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