1. Finger thoracostomy in patients with chest trauma performed by paramedics on a helicopter emergency medical service.
- Author
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Hannon, Liam, St Clair, Toby, Smith, Karen, Fitzgerald, Mark, Mitra, Biswadev, Olaussen, Alexander, Moloney, John, Braitberg, George, Judson, Rodney, Teague, Warwick, Quinn, Nuala, Kim, Yesul, and Bernard, Stephen
- Subjects
CARDIAC arrest ,CHEST X rays ,EMERGENCY medical services ,LONGITUDINAL method ,MEDICAL records ,PATIENTS ,TRAFFIC accidents ,WOUNDS & injuries ,RETROSPECTIVE studies ,SEVERITY of illness index ,CHEST (Anatomy) ,DESCRIPTIVE statistics ,THORACOSTOMY - Abstract
Objective: To determine the frequency of finger thoracostomy performed by intensive care flight paramedics after the introduction of a training programme in this procedure and complications of the procedure that were diagnosed after hospital arrival. Methods: This was a retrospective cohort study of adult and paediatric trauma patients undergoing finger thoracostomy performed by paramedics on a helicopter emergency medical service between June 2015 and May 2018. Hospital data were obtained through a manual search of the medical records at each of the three receiving major trauma services. Additional data were sourced from the Victorian State Trauma Registry. Results: The final analysis included 103 cases, of which 73.8% underwent bilateral procedures with a total of 179 finger thoracostomies performed. The mean age of patients was 42.8 (standard deviation 21.4) years and 73.8% were male. Motor vehicle collision was the most common mechanism of injury accounting for 54.4% of cases. The median Injury Severity Score was 41 (interquartile range 29–54). There were 30 patients who died pre‐hospital, with most (n = 25) having finger thoracostomy performed in the setting of a traumatic cardiac arrest. A supine chest X‐ray was performed prior to intercostal catheter insertion in 38 of 73 patients arriving at hospital; of these, none demonstrated a tension pneumothorax. There were three cases of potential complications related to the finger thoracostomy. Conclusion: Finger thoracostomy was frequently performed by intensive care flight paramedics. It was associated with a low rate of major complications and given the deficiencies of needle thoracostomy, should be the preferred approach for chest decompression. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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