What is Emergency Medicine - What is the preferred field intervention for treating tension pneumothorax?
The second most common preventable cause of mortality on the battlefield is tension pneumothorax. The preferred method for decompressing the chest is a finger or needle thoracostomy employing a large-bore (10-, 12-, or 14-gauge), long (minimum 3.25 in) over-the-needle catheter. Shorter or thinner catheters run the danger of failing to reach the chest cavity or remove air. In 99% of the soldiers examined for this study, a 3.25-inch catheter was able to reach the pleura. The second intercostal gap near the midclavicular line, above the rib, is the typical location for the catheter. A lateral access at the fourth intercostal space in the mid or anterior axillary line may be necessary due to ballistic vests or body mass. With a finger or curved Kelly forceps, an opening is made in the pleura above the rib using a minor incision at the fourth or fifth intercostal gap at the midanterior axillary line.
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