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.