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Home | CCC | Finger Thoracostomy

Finger Thoracostomy

by Dr Chris Nickson, last update April 1, 2019

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.

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About Dr Chris Nickson

An oslerphile emergency physician and intensivist suffering from a bad case of knowledge dipsosis. Key areas of interest include: the ED-ICU interface, toxicology, simulation and the free open-access meducation (FOAM) revolution. @Twitter | INTENSIVE| SMACC

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