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This could reduce some of the potential confounders in prior studies that were exclusively cadavers which may have differences in CWT due to post-mortem changes. These authors are adding to the literature by utilizing ultrasound on live patients. These studies were limited by heterogeneity (I2 83%-98%), possible publication bias, and not being randomized trials. There were also studies using CT scans showing a preference for the fourth/fifth ICS AAL. The changes in the ATLS guidelines were based in part on a small study (n=20) utilizing cadavers. The clinical question was does everyone with a large first-time spontaneous pneumothorax need a chest tube? The answer from that episode was It is reasonable to provide conservative management (no chest tube) in a patient with large first-time spontaneous pneumothoraxes if you can ensure close follow-up. The other episode on chest tubes was SGEM#300.

Be more concerned if the patient is doing poorly or the tube is not draining. Continue to obtain a CXR post chest tube knowing it will probably not change management. The conclusion from that episode was to put the tube on the correct side, within the triangle of safety, and within the pleural space. SGEM#129 looked at where to put the chest tube on trauma patients and if a post-procedure chest Xray (CXR) was required. We have covered chest tube thorocostomy a couple of times on the SGEM with Dr. Needle thoracostomy is subject to several complications compared to a tube thoracostomy primarily due to the shorter length of the needle as well as the smaller lumen, so site selection has focused on finding a short distance and a site unlikely to kink or get dislodged. There were several changes to the new guidelines but one of them was changing the location for needled decompression for adult patients. We covered them on the SGEM Xtra with Dr.

After obtaining consent from the patient, you debate whether to decompress at the second intercostal space in the midclavicular line as you originally learned, or in the fourth/fifth intercostal space midaxillary line as per the current ATLS guidelines.īackground: The latest ATLS guidelines were published in 2018. You notice a marked difference between breath sounds on the left side and decide the patient needs treatment for a tension pneumothorax. As you wait for EMS to arrive, you quickly dash back to your car to retrieve your stethoscope and an angiocatheter you have in your glovebox.

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He is speaking in full sentences without confusion, has a strong, rapid pulse, significant pain in his chest and is having a very hard time breathing. After safely pulling over and having a bystander call 911, you evaluate the patient.

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The driver is a restrained self-extricated male who lost control of his vehicle into a light post and the vehicle’s airbags deployed.

This is Bob’s 14th episode cohosting the SGEM.ĭISCLAIMER: THE VIEWS AND OPINIONS OF THIS PODCAST DO NOT REPRESENT THE UNITED STATES GOVERNMENT OR THE US AIR FORCE.Ĭase: You are driving home from a busy shift and see a car collision occur right in front of you. Robert Edmonds is an emergency physician in the Air Force in Ohio. Optimal anatomical location for needle decompression for tension pneumothorax: A multicenter prospective cohort study.