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Issue link: https://emsworld.epubxp.com/i/469414
28 MARCH 2015 | EMSWORLD.com Y ou're a young resident physician on the first ridealong of your EMS rotation. The shift has been dull until boom!—a call comes over the radio, and suddenly lights and siren are at full blare. When the truck screeches to a stop, you hear the front doors open and people screaming outside. You mobilize the monitor and supply bag and wait for the back doors to open to jump out. However, when they open paramedics and firefighters quickly load up a 20-something African-American female who's been shot in the chest. Once she's loaded the EMT calls out vitals: heart rate, 60; blood pressure, 70/40; respiratory rate, 22; oxygen saturation, 99%. You start your ATLS exam. Her airway is midline and patent. Breathing is clear on the left, decreased breath sounds on the right. You palpate weak pulses in the bilateral radial wrists. You remove the patient's undergarments and note a gunshot wound to the right parasternal area. The pa ra med ic con- firms your findings and instructs you to needle- decompress the chest: "You know where to do it, right? Second intercostal space, midclavicular line. Here is the needle." As you're about to decom- press the patient with a 14-gauge angiocatheter, you wonder if there is a better place to do it. Discussion A retrospective review of patients undergoing needle decompression by prehospital providers concluded the proce- dure is safe to perform and, when done in the decompensating trauma patient, can have ben- eficial outcomes. 16 Traditionally the recommended needle thoracostomy site has been the second inter- costal space, midclavicular line (2ICS-MCL). How - ever, within the last 15–20 years, this has come into question on multiple fronts. Recent data may cause us to reconsider our preferred thoracostomy location By Daniel Charles Kolinsky, MD, & Hawnwan Philip Moy, MD EVIDENCE-BASED EMS: Needle Decompression NEEDLE DECOMPRESSION Insertion site for needle chest decompression procedure. Photo cour tesy of MEDRILL s (www.medrills.com).