Liam Hannon1,2, Toby St Clair1,3,4, Karen Smith1,3,5, Mark Fitzgerald1,6,7, Biswadev Mitra5,6,7, Alexander Olaussen5,6,7, John Moloney1,6, George Braitberg1,8,9, Rodney Judson9, Warwick J. Teague4, Nuala Quinn4, Yesul Kim7, Stephen Bernard1,5,6
1Ambulance Victoria, Melbourne, Victoria, Australia
2Emergency Department, Bendigo Health, Bendigo, Victoria, Australia
3Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia
4Department of Trauma, The Royal Children's Hospital, Melbourne, Victoria, Australia
5Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
6Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
7National Trauma Research Institute, Melbourne, Victoria, Australia
8Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
9Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
Tóm tắt
AbstractObjectiveTo 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.MethodsThis 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.ResultsThe 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.ConclusionFinger 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.
