Abstract
Introduction:Needle decompression of a tension pneumothorax can be a lifesaving procedure. It requires an adequate needle length to reach the chest wall to rapidly remove air. With adult obesity exceeding one third of the United States population in 2010, we sought to evaluate the proper catheter length that may result in a successful needle decompression procedure. Advance Trauma Life Support (ATLS) currently recommends a 51 millimeter (mm) needle, while the needles stocked in our emergency department are 46 mm. Given the obesity rates of our patient population, we hypothesize these needles would not have a tolerable success rate of 90%.Methods:We retrospectively reviewed 91 patient records that had computed tomography of the chest and measured the chest wall depth at the second intercostal space bilaterally.Results:We found that 46 mm needles would only be successful in 52.7% of our patient population, yet the ATLS recommended length of 51 mm has a success rate of 64.8%. Therefore, using a 64 mm needle would be successful in 79% percent of our patient population.Conclusion:Use of longer length needles for needle thoracostomy is essential given the extent of the nation’s adult obesity population.
Highlights
Needle decompression of a tension pneumothorax can be a lifesaving procedure
We found that 46 mm needles would only be successful in 52.7% of our patient population, yet the Advance Trauma Life Support (ATLS) recommended length of 51 mm has a success rate of 64.8%
The current American College of Surgeons Advanced Trauma Life Support (ATLS) guidelines advocate the use of a 51 mm (2 inch) needle for needle decompression for tension pneumothoraces.[1]
Summary
Needle decompression of a tension pneumothorax can be a lifesaving procedure. It requires an adequate needle length to reach the chest wall to rapidly remove air. With adult obesity exceeding one third of the United States population in 2010, we sought to evaluate the proper catheter length that may result in a successful needle decompression procedure. Tension pneumothorax is a devastating and fatal injury pattern that requires the rapid removal of air via needle decompression of the thoracic cavity as an essential lifesaving technique.[1] The current American College of Surgeons Advanced Trauma Life Support (ATLS) guidelines advocate the use of a 51 mm (2 inch) needle for needle decompression for tension pneumothoraces.[1] The United States is experiencing an increasing problem with obesity, Inaba et al[2] discussed alternate sites for decompression based on computed tomography (CT) and postulated a change in site of needle decompression. Based on a review of the literature and clinical experience, Needle Decompression in Appalachia our hypothesis was that the ATLS recommended needle length of 51 mm would not be sufficient in 90% of our patients.[6,7,8,9]
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