Lecture: Finger Thoracostomy for Tension Pneumothorax
Introduction
- Presenter: Sam
- Context: Demonstration on how to perform a finger thoracostomy
- Important Notices:
- Follow local policies, procedures, and laws before performing medical interventions.
- Good Samaritan laws do not cover this procedure.
- Views expressed are personal, not of the employer.
- No endorsement of specific equipment.
What is a Tension Pneumothorax?
- Definition: Occurs when a lung collapses and pressure builds in the thoracic cavity, potentially leading to obstructive shock.
- Effects:
- Collapse of great vessels and heart stoppage
- Symptoms vary and are difficult to identify
Signs and Symptoms
- Increased work of breathing if conscious
- Difficulty with bag-valve-mask ventilation or increased PIPs on a ventilator
- Common shock symptoms:
- Hypotension, tachycardia, and bradycardia
- Diminished lung sounds on one side (not always detectable)
- Trachea deviation as a late sign
Distinguishing Factors
- Traumatic Scenario: More likely hemorrhagic shock than obstructive shock
- Treat tension pneumothorax immediately upon identification
Procedure: Finger Thoracostomy
- Time: Can be performed in under 20 seconds with practice
- Required Equipment:
- PPE: Gloves and face mask
- Size 10 scalpel, curved Kelly forceps
- Occlusive dressing (preferably vented chest seal)
- Site Identification:
- Perform at the 4th or 5th intercostal space
- Avoid cutting into the pectoralis major muscle
- Use the inframammary fold as a landmark
Performing the Procedure
- Preparation:
- Identify the correct site
- Open and prepare supplies
- Clean the incision site
- Incision:
- Make a 3-4 cm incision over the rib
- Avoid the neurovascular bundle under the rib
- Blunt Dissection:
- Use Kelly clamps to blunt dissect and enlarge the hole
- Insert the finger to ensure the correct space
- Feel for lung tissue if inflating
- Seal:
- Apply an occlusive dressing
- Reopen as necessary if pneumothorax reoccurs
Potential Risks
- To Provider: Risk of injury from sharp rib fractures
- To Patient: Risk of improper procedure and exposure
Conclusion
- Feedback: Encouraged comments and questions
- Next Steps: Follow up in the next video
These notes summarize the procedure and considerations for performing a finger thoracostomy to relieve tension pneumothorax. Always prioritize safety, legality, and proper technique.