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 in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of two amazing children.
On Twitter, he is @precordialthump.
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