Ver el código de «Finger thoracostomy»

==Overview==
*The '''finger thoracostomy''' is an alternative to [[needle thoracostomy]] for emergent decompression of a suspected [[tension pneumothorax]]<ref>Smith T, Wilbeck J. Finger Thoracostomy for Tension Pneumothorax. Adv Emerg Nurs J. 2024 Jan-Mar 01;46(1):44-48. PMID 38285421</ref>
*Numerous studies suggest that needle thoracostomy inconsistently accesses the pleural space
*This alternative procedure allows for tactile (+/- visual) feedback that the pleural space has been accessed
*Will cause an open pneumothorax. 
*Has ''not'' been studied head-to-head against needle thoracostomy
**Thus, any advantages/disadvantages are currently based on expert opinion rather than strong evidence

==Indications==
*Clinical [[tension pneumothorax]]

==Contraindications==
*Local trauma: possibility of sharp bone fragment/foreign body

==Equipment Needed==
*sterile gloves
*scalpel
*Kelly clamp
*betadine
*lidocaine, syringe, needle

==Procedure==
[[File:Gray530.png|thumb|Left pleura cavity (viewed from left) showing intercostal bundles (vein, artery, and nerve) directly '''under''' the ribs.]]
#Recognize possible tension physiology.
#Locate 5th intercostal space at anterior/mid-axillary line.
#Clean with betadine.
#Consider lidocaine/local anesthetic: reconsider if in a trauma code, or based on urgency of access/stability of patient.
#*If patient is awake/alert, anesthetize the skin, muscle and down to pleura.
#Don sterile gloves.
#Using a No. 10/11 scalpel, make a 4cm through skin over and parallel to the superior border of the inferior rib.
#Using Kelly clamps, quickly blunt dissect through subcutaneous tissue and muscle just over the superior border of the inferior rib.
#With closed Kelly clamps, puncture through the parietal pleura.
#*the "give" of the parietal pleura indicates access of the pleural space
#*if tension hemopneumothorax is present, you may hear a "whoosh" of air or note swift return of blood
#Remove the Kelly clamps from the tract and insert your full gloved finger into the space.
#*intrapleural palpation confirms access of the pleural space
#*re-expansion of the lung parenchyma may be palpated, especially if patient is receiving positive pressure ventilation (e.g. intubated)
#If lung is already expanded on palaption and there is no forceful air/fluid release, it may be possible to close the thoracic wound with occlusive dressing, obviating further tube thoracostomy.
#If tension physiology confirmed on finger thoracostomy, place an urgent [[chest tube]] when resuscitation allows.

==Advantages==
*advantages over needle thoracostomy:
**unlimited by needle length
**observable signs confirming pleural access
***puncture sensation of parietal pleura with Kelly/finger
***palpation of parietal pleura with finger
***palpation of lung parenchyma with finger
**if no pneumothorax, will not puncture lung parenchyma to create new pneumothorax
***theoretically does not require placement of [[chest tube]] if no initial pneumothorax
**no chance of catheter "kinking"
*advantages over tube thoracostomy
**simpler: quicker, easier, less equipment
**no foreign body, decreased infection
==Disadvantages==
*slower to perform than needle decompression
*more steps/equipment than needle decompression
*no tube holding tract open; may seal off during resuscitation/movement/transport
==See Also==
*[[tension pneumothorax]]
*[[needle thoracostomy]]
*[[chest tube]]
==External Links==
*https://emcrit.org/emcrit/needle-finger-thoracostomy/
*http://regionstraumapro.com/post/38306629710
*http://www.tamingthesru.com/blog/acmc/finger-thoracostomy
==References==
<references/>
*Fitzgerald M, Mackenzie CF, Marasco S, Hoyle R, Kossmann T. Pleural decompression and drainage during trauma reception and resuscitation. Injury. 2008 Jan;39(1):9-20. doi: 10.1016/j.injury.2007.07.021. Review. PubMed PMID:18164300.
*Stevens RL, Rochester AA, Busko J, Blackwell T, Schwartz D, Argenta A, Sing RF. Needle thoracostomy for tension pneumothorax: failure predicted by chest computed tomography. Prehosp Emerg Care. 2009 Jan-Mar;13(1):14-7. doi: 10.1080/10903120802471998. PubMed PMID: 19145519.
*Ball CG, Wyrzykowski AD, Kirkpatrick AW, Dente CJ, Nicholas JM, Salomone JP, Rozycki GS, Kortbeek JB, Feliciano DV. Thoracic needle decompression for tension pneumothorax: clinical correlation with catheter length. Can J Surg. 2010 Jun;53(3):184-8. PubMed PMID: 20507791; PubMed Central PMCID: PMC2878990.
*Zengerink I, Brink PR, Laupland KB, Raber EL, Zygun D, Kortbeek JB. Needle
thoracostomy in the treatment of a tension pneumothorax in trauma patients: what 
size needle? J Trauma. 2008 Jan;64(1):111-4. doi:
10.1097/01.ta.0000239241.59283.03. PubMed PMID: 18188107.
*Deakin CD, Davies G, Wilson A. Simple thoracostomy avoids chest drain insertion in prehospital trauma. J Trauma. 1995 Aug;39(2):373-4. PubMed PMID:7674410.

[[Category:Procedures]]
[[Category:Critical Care]]