Finger Thoracostomies

From teaching round–Courtesy of Mene Demestihas:

In a patient in cardiopulmonary arrest, going through the H’s and T’s can lead us to suspect a tamponade or compressive physiology as the culprit of the arrest.

In these patients placing a formal chest tube is generally frowned upon as it can be a labor-intensive process for a potentially small yield. While needle decompression of the chest has long been a standard move in this situation, Scott Weingart (@EMCrit) of the EMCrit Blog has a great post in one of his airway segments that deals with the finger thoracostomy.

The high points:

  • the usual IV catheter doesn’t reach in most cases
  • we don’t do a good job with an anterior approach to the needle decompression
  • great video showing “how to”

You don’t have to take my word for it, go on over and get a healthy dose of #FOAMed!

Blog Post

~ Mene Demestihas, MD

menelaos@emory.edu

@menelaosMD & @EmoryEM

5 comments

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    • Eric Deutsch on June 6, 2014 at 3:38 pm

    If you get ROSC are you then placing bilateral chest tubes or just closing these incisions?

  1. I’d say you’d need bilateral chest tubes at your thoracostomy sites.

    • Ben Lefkove on June 6, 2014 at 5:25 pm

    yes you have to place Bilateral chest tubes after ROSC.

    • Eric Deutsch on June 7, 2014 at 12:34 pm

    Interestingly in the podcast Mene referenced Weingart advocates not placing chest tubes if there is no rush of air/blood. His argument is that since you used your finger and not a needle you shouldn’t cause any damage to the parenchyma and shouldn’t develop a pneumo like you would if you used a needle. I think I would place chest tubes – if you did a bunch of different things during the code it’s hard to say which contributed to the ROSC, you have the incisions already, and the tubes can always be pulled in a few days if there is no air leak.

    • Sean on June 7, 2014 at 3:53 pm

    Thanks for your post Eric. The argument makes sense. My thought is that it’s hard to hear the rush of air, also you are likely breaking ribs during compressions….and, like you said, if you get rosc it’s hard to know what led to it. Might as well put in the tubes.

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