In part 1 & 2 Cynthia discusses techniques for releasing tension physiology in the form of a needle or chest tube. In this episode we will look at the logistics of performing a finger thoracostomy and the evidence to support it. Special thanks to Cliff Reid for allowing us to use the finger thoracostomy footage you see at the head of this episode.
Do we need to place these patients on PPV?
Yes.. When you make a hole in the patients pleura and insert your finger, you will be opening this typically negative pressure cavity to atmospheric pressure. In order for the patient to create enough inspiratory flow they will need to generate a significant negative pressure swings. The trauma literature will tell you that a sucking chest wound occurs when the chest hole is greater than two thirds of the trachea width. The issue is that the trachea is not the first thing air sees in the beginning of inspiration. The air must make it through the orapharynx before it reaches that point. When you are playing with millimeters it is best to place the patient on positive pressure ventilation unless you will be placing a chest tube with Heimlich valve.
ATACC Guidelines
Other stuff
My buddy and friend to the show Carmine Della Vella has launched a new website www.intubati.org. Great site packed with airway content. It is all in Italian, so make sure you scroll to the bottom and hit the English button.
PDF Show Notes:
https://www.dropbox.com/sh/p87lkhd496fig9r/AADDheM-owbIcingGKa18A5ba?dl=0