• J Emerg Med · Oct 2022

    Observational Study

    Using Ultrasound to Determine Optimal Location for Needle Decompression of Tension Pneumothorax: A Pilot Study.

    • Mathew Nelson, Yash Chavda, Brendon Stankard, Molly McCann-Pineo, Alexander Nello, and Andrew Jersey.
    • Department of Emergency Medicine, North Shore University Hospital, Manhasset, New York.
    • J Emerg Med. 2022 Oct 1; 63 (4): 528532528-532.

    BackgroundChest injury can result in life-threatening complications like tension pneumothorax, in which rapid deterioration can occur without decompression. Traditionally, the second intercostal space (ICS) along the mid-clavicular line is taught as the site for decompression. However, this has been questioned due to high rates of treatment failure. The fifth ICS on the mid-axillary line (MAL) is hypothesized to have a shorter distance from skin to pleura based on recent studies.ObjectiveThe purpose of this study was to use point-of-care ultrasound (POCUS) to compare chest wall thickness at these two locations. The primary objective was to evaluate the distance from skin to pleura line at the second ICS along the mid-clavicular line and the fifth ICS along the MAL. Secondarily, we aimed to evaluate inter-rater reliability of the two assessments.MethodsThis was a single-center, observational, pilot study. POCUS was performed using a linear transducer. Measurements of skin to pleura line were obtained at the right second ICS and fifth ICS. These measurements were then repeated by a blinded second ultrasonographer. Intraclass correlations (ICCs) for each measurement site were calculated to determine the inter-rater reliability.ResultsNinety-three percent of volunteers had a smaller chest wall distance at the fifth ICS-MAL. The median distance at the second and fifth ICS was 2.28 cm and 1.80 cm. The ICC for second ICS was 0.75 (95% CI 0.54-0.87), and 0.90 for the fifth ICS (95% CI 0.81-0.95), both indicating good reliability.ConclusionsThe data support that patients have a smaller chest wall distance at the fifth ICS vs. the second ICS. We support performing needle decompression at the fifth ICS and believe POCUS can be used to determine the optimal location for decompression.Copyright © 2022 Elsevier Inc. All rights reserved.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…