Emergent needle thoracostomy in prehospital trauma patients: a review of procedural execution through computed tomography scans

Abstract

BackgroundTraumatic tension pneumothoraces (TPT) are among the most serious causes of death in traumatic injuries, requiring immediate treatment with a needle thoracostomy (NT). Improperly placed NT insertion into the pleural cavity may fail to treat a life-threatening TPT. This study aimed to assess the accuracy of prehospital NT placements by paramedics in adult trauma patients.MethodsA retrospective chart review was performed on 84 consecutive trauma patients who had received NT by prehospital personnel. The primary outcome was the accuracy of NT placement by prehospital personnel. Comparisons of various variables were conducted between those who survived and those who died, and proper versus improper needle insertion separately.ResultsProper NT placement into the pleural cavity was noted in 27.4% of adult trauma patients. In addition, more than 19% of the procedures performed by the prehospital providers appeared to have not been medically indicated.DiscussionLong-term strategies may be needed to improve the capabilities and performance of prehospital providers’ capabilities in this delicate life-saving procedure.Level of evidenceIV.

Paramedic Understanding of Tension Pneumothorax and Needle Thoracostomy (NT) Site Selection

“…Commonly listed symptoms of abnormal breath sounds, shortness of breath, tracheal deviation, and evaluation of the chest align with the Advanced Trauma Life Support (ATLS) dictum that "the presence of acute respiratory distress, subcutaneous emphysema, absent breath sounds, hyperresonance to percussion, and tracheal shift supports the diagnosis and warrants immediate thoracic decompression" [5]. Importantly, in one retrospective study from 2021 looking at 84 consecutive patients who had undergone NT in the field, 19% of the procedures performed appeared to have not been medically indicated [11].…”

“…Studies have looked at both its efficacy [11,15] and its safety [8,16] with proposals for different locations [7,12], equipment [17][18][19], and abandoning it all together in favor of finger thoracostomy [20]. This study adds to the impetus to improve upon the procedure by suggesting the preferred site for NT is simply difficult to find.…”

Comparison of Patterns and Demographics of Isolated Traumatic Mandibular Fracture Between Incarcerated and General Populations

“…ARMC is a 456-bed acute care teaching facility and an American College of Surgeons certified level I trauma center in San Bernardino County, California. The ARMC emergency department (ED) is one of the busiest in the state of California with more than 100,000 visits and over 3,000 adult trauma cases annually [ 5 ].…”