Articles: thoracostomy-instrumentation.
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Image-guided small catheter tube thoracostomy (SCTT) is not currently used as a first-line procedure in the management of patients with chest trauma. We adopted a practice recommendation to use SCTT as a less invasive alternative in the treatment of chest injuries. We reviewed our trauma registry to evaluate our change in practice and the effectiveness of SCTT. ⋯ SCTT is effective in managing chest trauma. It is comparable with LCTT in stable trauma patients. This study supports adopting image-guided small catheter techniques in the management of chest trauma in stable patients.
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Multicenter Study Comparative Study
Outcomes of emergency department patients treated for primary spontaneous pneumothorax.
International guidelines for the management of primary spontaneous pneumothorax (PSP) vary, and there is growing opinion that more patients could be successfully managed with observation alone. There is little published evidence detailing the outcomes of emergency department (ED) patients who have been treated for PSP. The aim of this study was to describe the clinical outcomes for patients with PSP. ⋯ These data suggest that observation alone is an effective initial treatment strategy for selected patients with PSP. They support the inclusion of an observation arm in planned prospective studies comparing different management approaches.
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The use of prehospital needle thoracostomy (NT) is controversial as it is not without risk. Issues such as inappropriate patient selection, misplacement causing iatrogenic injury, treatment failures in obese patients, and delaying definitive tube thoracostomy in the emergency department contribute to this controversy. The purpose of this study is to evaluate a cohort of patients undergoing NT by paramedics for tension pneumothorax and review the indications for use, complications, and emergency department outcomes of NT. ⋯ The use of NT appears to be a safe procedure when preformed by paramedics in an urban EMS system. Prehospital NT resulted in four cases of unexpected survival.
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Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle?
A tension pneumothorax requires immediate decompression using a needle thoracostomy. According to advanced trauma life support guidelines this procedure is performed in the second intercostal space (ICS) in the midclavicular line (MCL), using a 4.5-cm (2-inch) catheter (5-cm needle). Previous studies have shown a failure rate of up to 40% using this technique. Case reports have suggested that this high failure rate could be because of insufficient length of the needle. ⋯ A catheter length of 4.5 cm may not penetrate the chest wall of a substantial amount (9.9%-35.4%) of the population, depending on age and gender. This study demonstrates the need for a variable needle length for relief of a tension pneumothorax in certain population groups to improve effectiveness of needle thoracostomy.