Finger Thoracostomy
Indications
- Any pneumothorax in a patient undergoing positive pressure ventilation
- Actual or near traumatic cardiac arrest
- Shocked state with no apparent cause
- Pleural drainage is not indicated in drowning or hangings unless pneumothorax is diagnosed. Remember pleural decompression will reduce the efficiency of the ACD and impedance valve
Advantages
- The lung can be felt / seen to re-expand
- If the patient persists in a shocked state during transport, the thoracostomy can be “re-fingered” to ensure the lung is up, thus excluding one cause of obstructive shock
- Avoids intubation of the chest in a non-clinical area
- Avoids risk of re-tension caused by blockage and kinking of drainage systems
Disadvantages
- Invasive
- Risk of thoracostomy becoming occluded by patient’s arms when packaged
References and Links
FOAM and web resources
- Trauma Professional’s Blog — Why I Don’t Like Finger Thoracostomy
- EMCrit — Needle vs. Finger Thoracostomy
Journal articles
- Deakin CD, Davies G, Wilson A. Simple thoracostomy avoids chest drain insertion in prehospital trauma. J Trauma. 1995 Aug;39(2):373-4. [PMID 7674410]
- Fitzgerald M, Mackenzie CF, Marasco S, Hoyle R, Kossmann T. Pleural decompression and drainage during trauma reception and resuscitation. Injury. 2008 Jan;39(1):9-20. PMID: 18164300.
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC