EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.
Issue link: https://emsworld.epubxp.com/i/469414
NEEDLE DECOMPRESSION 34 MARCH 2015 | EMSWORLD.com risk of injury becomes almost equivalent. 5 At this time there have been no large-scale prospective randomized controlled trials or meta-analyses that have led to a consensus statement. As a result, current practice is based on the various smaller retrospective studies. These studies present weak if not conflicting data. As such, it is difficult to make a new Grade A recommendation to transi- tion to the fourth/fifth inter- costal space at the anterior axillary line as the primary site for needle decompression. REFERENCES 1. Beckett A, et al. Needle Decompression for Tension Pneumothorax in Tactical Combat Casualty Care: Do Catheters Placed in the Midaxillary Line Kink More Often Than Those in the Midclavicular Line? J Trauma, 2011; 71: S408–12. 2. Britten S, Palmer SH. Chest wall thickness may limit adequate drainage of tension pneumothorax by needle thoracocentesis. J Accid Emerg Med, 1996 Nov; 13(6): 426–7. 3. Butler KL, et al. Pulmonary Artery Injury and Cardiac Tamponade after Needle Decompression of a Suspected Tension Pneumothorax. J Trauma, 2003; 54: 610–11. 4. Carter TE, et al. Needle Decompression in Appalachia Do Obese Patients Need Longer Needles? West J Emerg Med, 2013; 14(6): 650–2. 5. Chang SJ, et al. Evaluation of 8.0-cm needle at the fourth anterior axillary line for needle chest decompression of tension pneumothorax. J Trauma Acute Care Surg, 2014 Apr; 76(4): 1,029–34. 6. Committee on Trauma, American College of Surgeons. ATLS: Advanced Trauma Life Support— Student Course Manual, 9th ed. Chicago: American College of Surgeons, 2012. 7. Defense Health Board. Decompression of Tension Pneumothorax Tactical Combat Casualty Care Guideline Recommendations 2012-05. J Special Op Med, 2012; 12(4): 118–22. 8. Ferrie EP, Collum N, McGovern S. The right place in the right space? Awareness of site for needle thoracocentesis. Emerg Med J, 2005 Nov; 22(11): 788–9. 9. Inaba K, et al. Optimal Positioning for Emergent Needle Thoracostomy: A Cadaver-Based Study. J Trauma, 2011; 71: 1,099–103. 10. Inaba K, et al. Radiologic evaluation of alternative sites for needle decompression of tension pneumothorax. Arch Surg, 2012 Sep; 147(9): 813–8. 11. Martin M, Satterly S, Inaba K, Blair K. Does needle thoracostomy provide adequate and ef fective decompression of tension pneumothorax? J Trauma Acute Care Surg, 2012 Dec; 73(6): 1,412–7. 12. Miller AC, et al. Guidelines for the management of spontaneous pneumothorax. BMJ, 1993; 307: 114–16. 13. Rawlins R, et al. Life threatening haemorrhage after anterior needle aspiration of pneumothoraces. A role for lateral needle aspiration in emergency decompression of spontaneous pneumothorax. Emerg Med J, 2003 Jul; 20(4): 383–4. 14. Sanchez LD, et al. Anterior versus lateral needle decompression of tension pneumothorax: comparison by computed tomography chest wall measurement. Acad Emerg Med, 2011 Oct; 18(10): 1,022–6. 15. Stevens RL, et al. Needle thoracostomy for tension pneumothorax: failure predicted by chest computed tomography. Prehosp Emerg Care, 2009 Jan-Mar; 13(1): 14–7. 16. Warner KJ, Copass MK, Bulger EM. Paramedic use of needle thoracostomy in the prehospital environment. Prehosp Emerg Care, 2008 Apr–Jun; 12(2): 162–8. 17. Wax DB, et al. Radiologic assessment of potential sites for needle decompression of a tension pneumothorax. Anesth Analg, 2007 Nov; 105(5): 1,385–8. ABOUT AIRON CORPORATION Airon is dedicated to the development, manufacture, and distribution of safe and efective medical devices designed for life support. Teir expertise and focus is on pure pneumatic technology that provides dependable, robust respiratory support of neonates up to the largest adults. HIGH QUALITY ICU VENTILATOR TYPE CPAP SYSTEMS Airon's products are in use at hospitals and EMS agencies throughout the world. Airon believes in the efectiveness of non-invasive ventilation and designs all of their products with superior CPAP systems to maximize clinical utility. Recent published research indicates that Airon's adult ventilators have CPAP systems that are equal to or better than modern ICU ventilators. RESPIRATORY THERAPISTS WITH CLINICAL EXPERIENCE Te founders and senior management at Airon are respiratory therapists who have decades of proven experience working with clinicians in hospitals and EMS. As a customer-focused company that draws from the clinical experience of their staf and users, Airon makes easy-to-use, robust products that meet the requirements of EMS. MANUFACTURED IN USA, AVAILABLE WORLDWIDE Airon's operations and products comply with local, national, and international regulations. Every device is manufactured in their own ISO 13485/9001 certifed facility in Melbourne, Florida. Teir products are all CE marked as well as USA FDA approved. Airon will only ship products that meet their customers' quality requirements. To learn more about Airon and how they help EMS professionals obtain improved patient outcomes, visit AironUSA.com Airon Providing Ventilation and CPAP Systems to EMS since 2003. P R O F I L E For More Information Circle 31 on Reader Service Card Daniel Charles Kolinsky, MD, is a second-year emergency medicine resident physician at Washington University in St. Louis, and a graduate of Louisiana State University Health Sciences Center. His professional interests include medical education, patient- physician dynamics, and EMS critical care. Hawnwan Philip Moy, MD, is an assistant medical director of the Saint Louis City Fire Department, and emergency medicine clinical instructor and core faculty of the EMS Section of the Division of Emergency Medicine at Washington University in Saint Louis, MO. He completed his emergency medicine residency at Barnes Jewish Hospital/ Washington University in Saint Louis and his EMS fellowship at the University of North Carolina in Chapel Hill. ABOUT THE AUTHORS