Patrick Thompson, Angelo Ciarglia, Erin Handspiker, Christopher Bjerkvig, James A Bynum, Elon Glassberg, Jennifer M Gurney, Anthony J Hudson, Donald H Jenkins, Susannah Nicholson, Geir Strandenes, Maxwell A Braverman
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Measurements were taken at 2nd ICS mid clavicular line (MCL), 5th ICS AAL and distance from the skin to pericardium at 5th ICS AAL. Groups were compared using Mann-Whitney U and chi-squared tests.</p><p><strong>Results: </strong>The median age was 27 years with median BMI of 23.8 kg/m2. The cohort was 69.5% male. Mean chest wall thickness at 2nd ICS MCL was 38-mm (interquartile range (IQR) 32-45). At 5th ICS AAL, the median chest wall thickness was 30-mm (IQR 21-40) and the distance from skin to pericardium was 66-mm (IQR 54-79).</p><p><strong>Conclusion: </strong>The distance from skin to pericardium for 75% of patients falls within the length of the recommended needle catheter unit (83-mm). The current TCCC recommendation to \"hub\" the 83mm needle catheter unit has potential risk of cardiac injury.</p>","PeriodicalId":53630,"journal":{"name":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk of Harm in Needle Decompression for Tension Pneumothorax.\",\"authors\":\"Patrick Thompson, Angelo Ciarglia, Erin Handspiker, Christopher Bjerkvig, James A Bynum, Elon Glassberg, Jennifer M Gurney, Anthony J Hudson, Donald H Jenkins, Susannah Nicholson, Geir Strandenes, Maxwell A Braverman\",\"doi\":\"10.55460/ZU1D-3DL9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Tension pneumothorax (TPX) is the third most common cause of preventable death in trauma. Needle decompression at the fifth intercostal space at anterior axillary line (5th ICS AAL) is recommended by Tactical Combat Casualty Care (TCCC) with an 83-mm needle catheter unit (NCU). We sought to determine the risk of cardiac injury at this site.</p><p><strong>Methods: </strong>Institutional data sets from two trauma centers were queried for 200 patients with CT chest. Inclusion criteria include body mass index of =30 and age 18-40 years. Measurements were taken at 2nd ICS mid clavicular line (MCL), 5th ICS AAL and distance from the skin to pericardium at 5th ICS AAL. Groups were compared using Mann-Whitney U and chi-squared tests.</p><p><strong>Results: </strong>The median age was 27 years with median BMI of 23.8 kg/m2. The cohort was 69.5% male. Mean chest wall thickness at 2nd ICS MCL was 38-mm (interquartile range (IQR) 32-45). At 5th ICS AAL, the median chest wall thickness was 30-mm (IQR 21-40) and the distance from skin to pericardium was 66-mm (IQR 54-79).</p><p><strong>Conclusion: </strong>The distance from skin to pericardium for 75% of patients falls within the length of the recommended needle catheter unit (83-mm). The current TCCC recommendation to \\\"hub\\\" the 83mm needle catheter unit has potential risk of cardiac injury.</p>\",\"PeriodicalId\":53630,\"journal\":{\"name\":\"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-06-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.55460/ZU1D-3DL9\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of special operations medicine : a peer reviewed journal for SOF medical professionals","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.55460/ZU1D-3DL9","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
摘要
简介:张力性气胸(TPX)是第三大最常见的原因,可预防的死亡在创伤。战术战斗伤亡护理(TCCC)推荐在腋窝前线第5肋间隙(第5 ICS AAL)使用83毫米针导管(NCU)进行针减压。我们试图确定该部位心脏损伤的风险。方法:对两家创伤中心的200例胸部CT患者资料进行查询。纳入标准:体重指数=30,年龄18-40岁。测量第2 ICS锁骨中线(MCL)、第5 ICS AAL和第5 ICS AAL皮肤到心包的距离。各组间比较采用Mann-Whitney U检验和卡方检验。结果:中位年龄27岁,中位BMI为23.8 kg/m2。该队列中男性占69.5%。第2次ICS MCL的平均胸壁厚度为38 mm(四分位间距(IQR) 32-45)。第5次ICS AAL时,胸壁中位厚度为30 mm (IQR 21-40),皮肤至心包距离为66 mm (IQR 54-79)。结论:75%的患者皮肤到心包的距离落在推荐的针导管单位长度(83-mm)之内。目前TCCC推荐的“枢纽”83mm针导管单元有心脏损伤的潜在风险。
Risk of Harm in Needle Decompression for Tension Pneumothorax.
Introduction: Tension pneumothorax (TPX) is the third most common cause of preventable death in trauma. Needle decompression at the fifth intercostal space at anterior axillary line (5th ICS AAL) is recommended by Tactical Combat Casualty Care (TCCC) with an 83-mm needle catheter unit (NCU). We sought to determine the risk of cardiac injury at this site.
Methods: Institutional data sets from two trauma centers were queried for 200 patients with CT chest. Inclusion criteria include body mass index of =30 and age 18-40 years. Measurements were taken at 2nd ICS mid clavicular line (MCL), 5th ICS AAL and distance from the skin to pericardium at 5th ICS AAL. Groups were compared using Mann-Whitney U and chi-squared tests.
Results: The median age was 27 years with median BMI of 23.8 kg/m2. The cohort was 69.5% male. Mean chest wall thickness at 2nd ICS MCL was 38-mm (interquartile range (IQR) 32-45). At 5th ICS AAL, the median chest wall thickness was 30-mm (IQR 21-40) and the distance from skin to pericardium was 66-mm (IQR 54-79).
Conclusion: The distance from skin to pericardium for 75% of patients falls within the length of the recommended needle catheter unit (83-mm). The current TCCC recommendation to "hub" the 83mm needle catheter unit has potential risk of cardiac injury.