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
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