Evaluation of 8.0-cm needle at the fourth anterior axillary line for needle chest decompression of tension pneumothorax By 曾奕璿 本檔僅供內部教學使用 檔案內所使用之照片之版權仍屬於原期刊 公開使用時, 公開使用時 須獲得原期刊之同意授權 BACKGROUND Tension pneumothorax: fatal Rapid hemodynamic collapse occurs Needle decompression: emergent tx 8th edition of ATLS in 2008: 5-cm 14 gauge needle at 2nd intercostal space (ICS), midclavicular line (2MCL) 8th edition of ATLS Failure is common (25-50%) Excessive chest wall thickness (CWT), user error, catheter malfunction, and obstruction Arterial injury, cardiac laceration, tamponade and hemothorax Newer suggestion by military => 8-cm needle at 2MCL => 2012: Defense Health Board 4-5th ICS anterior axillary line (AAL) Goal of this study 1. 2. 3. 8-cm at 4AAL: safe? Examine the impact of angle of entry (AOE) at 4AAL on RNI 8-cm at 2MCL 是否安全 Terms Radiographic decompression (RD): CWT < 8cm; 成功 Radiographic noninjury (RNI): > 8cm, failed but didn’t cause injuries Distance to vital structure (DVS): potential injury by NCD Participants and methods Participants First 100 adult Chest CT for blunt and penetrating trauma survey Methods chest CT 下針點 4AAL > 84 male, 16 female 23 px have pneumothorax 14 px : right 7 px : left 2 px: bilateral AOE: horizontal = 0 degree 4AAL-close = closest vital structure 4AAL-p = perpendicular to the chest wall Results: Mean CWT at 4AAL < 2MCL Shallower angles of entry were associated with closer distances to vital structures L-4AAL-close: lowest mean DVS and RNI rate Discussion of this study CWT: 4AAL is thinner than at 2MCL RD: 8cm (96%) vs 5cm (66%) RNI rate of 68-100% across all sites of study L-4AAL-close: 68% RNI rate (危險) All other sites had RNI rates > 91% Suggestion: 8-cm needle at a 90度 at the 4AAL (比2MCL好)
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