Needle thoracostomy in treatment of a tension pneumothorax in trauma patients.
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ABSTRACT: BACKGROUND: Tension pneumothorax (tPTX) is a common and potentially fatal event after thoracic trauma. Needle decompression is the currently accepted first-line intervention but has not been well validated. The purpose of this study was to evaluate the effectiveness of a properly placed and patent needle thoracostomy (NT) compared with standard tube thoracostomy (TT) in a swine model of tPTX. METHODS: Six adult swine underwent instrumentation and creation of tPTX using thoracic CO2 insufflation via a balloon trocar. A continued 1 L/min insufflation was maintained to simulate an ongoing air leak. The efficacy and failure rate of NT (14 gauge) compared with TT (34F) was assessed in two separate arms: (1) tPTX with hemodynamic compromise and (2) tPTX until pulseless electrical activity (PEA) obtained. Hemodynamics was assessed at 1 and 5 minutes after each intervention. RESULTS: A reliable and highly reproducible tPTX was created in all animals with a mean insufflation volume of 2441 mL. tPTX resulted in the systolic blood pressure declining 54% from baseline (128-58 mm Hg), cardiac output declining by 77% (7-1.6 L/min), and equalization of central venous pressure and wedge pressures. In the first arm, there were 19 tPTX events treated with NT placement. All NTs were patent on initial placement, but 5 (26%) demonstrated mechanical failure (due to kinking, obstruction, or dislodgment) within 5 minutes of placement, all associated with hemodynamic decline. Among the 14 NTs that remained patent at 5 minutes, 6 (43%) failed to relieve tension physiology for an overall failure rate of 58%. Decompression with TT was successful in relieving tPTX in 100%. In the second arm, there were 21 tPTX with PEA events treated initially with either NT (n = 14) or TT (n = 7). The NT failed to restore perfusion in nine events (64%), whereas TT was successful in 100% of events as a primary intervention and restored perfusion as a rescue intervention in eight of the nine NT failures (88%). CONCLUSION: Thoracic insufflation produced a reliable and easily controlled model of tPTX. NT was associated with high failure rates for relief of tension physiology and for treatment of tPTX-induced PEA and was due to both mechanical failure and inadequate tPTX evacuation. This performance data should be considered in future NT guideline development and equipment design.08/2012; DOI:10.1097/TA.0b013e31825ac511
Article: Prehospital Ultrasound[Show abstract] [Hide abstract]
ABSTRACT: Ultrasound is a commonly used diagnostic tool in clinical conditions. With recent developments in technology, use of portable ultrasound devices has become feasible in prehospital settings. Many studies also proved the feasibility and accuracy of prehospital ultrasound. In this article, we focus on the use of prehospital ultrasound, with emphasis on trauma and chest ultrasound.Journal of Medical Ultrasound 06/2014; DOI:10.1016/j.jmu.2014.05.008
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ABSTRACT: To describe the patient population, injuries, and treatment received on the battlefield, and ultimate outcome of U.S. military working dogs that incurred gunshot wound (GSW) injury in Operation Enduring Freedom (Afghanistan) or Operation Iraqi Freedom (Iraq). Retrospective study between January 2003 and December 2009. Twenty-nine military working dogs from the U.S. military with confirmed GSW injuries incurred in combat in Operation Enduring Freedom or Operation Iraqi Freedom. None. Clinical data from battlefield treatment, which includes care from the point of injury through arrival to, but not including, a designated veterinary treatment facility. Twenty-nine dogs were injured between 2003 and 2009. All but one of the injuries were from high caliber, high velocity weapons. Of the 29 injured dogs, 11 survived the injuries and 18 died (38% survival rate). Of the dogs that died, all but 1 died from catastrophic nonsurvivable injuries before treatment or evacuation could be instituted. The thorax was the most common site of injury (50%) followed by extremity wounds (46%). The leading cause of death from GSWs was from thoracic wounds, followed by head wounds. Dogs with extremity wounds as their only injury were most likely to survive, and dogs with multiple injuries were least likely to survive. All surviving dogs received treatment at the point of injury by military medics and dog handlers consistent with Tactical Combat Casualty Care guidelines for combat injuries in human service members. Of the 11 that survived, all dogs returned to full duty with subsequent deployment to combat zones. Location of wounds and injury severity at the time of presentation to veterinary care was not correlated with length of time until return to duty.01/2013; 23(1):47-52. DOI:10.1111/j.1476-4431.2012.00823.x