Average chest wall thickness at two anatomic locations in trauma patients
Elizabeth Schroeder1, Carrie Valdez, Andres Krauthamer
1Section of Trauma and Acute Care Surgery, Department of Surgery, George Washington University, United States.
Injury
|April 27, 2013
Summary
A 4.5cm catheter is too short for needle decompression of tension pneumothorax in most patients. This study found chest wall thickness often exceeds catheter length, irrespective of puncture site or patient gender.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Thoracic Procedures
Background:
- Needle decompression is the emergent treatment for tension pneumothorax.
- The standard 4.5cm catheter length may be inadequate.
- Optimal needle insertion sites remain debated.
Purpose of the Study:
- To determine if a 4.5cm catheter is sufficient for needle decompression.
- To evaluate chest wall thickness at potential insertion sites.
- To assess the influence of gender and BMI on chest wall thickness.
Main Methods:
- Retrospective review of trauma patient chest CT scans (2011).
- Measured chest wall thickness at the 2nd intercostal space (ICS), midclavicular line (MCL) and 5th ICS, anterior axillary line (AAL).
- Analyzed Injury Severity Score (ISS), chest wall thickness, and Body Mass Index (BMI).
Main Results:
- 201 patients included; average BMI 26 kg/m².
- Average chest wall thickness was 4.08cm (2nd ICS/MCL) and 4.55cm (5th ICS/AAL).
- Over 29% (2nd ICS/MCL) and 45% (5th ICS/AAL) had thickness >4.5cm; BMI correlated positively with thickness.
Conclusions:
- A 4.5cm catheter is inadequate for needle decompression in a significant portion of patients.
- Catheter length is insufficient regardless of puncture site or gender.
- Chest wall thickness, influenced by BMI, frequently exceeds available catheter length.
Related Concept Videos
01:26Flail Chest-II
Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
Assessment:
1. Clinical Evaluation:
History:
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
01:27Pneumothorax-II
Pneumothorax is a medical condition defined by the buildup of air in the pleural space between the lungs and the chest wall. This accumulation of air can lead to partial or complete lung collapse, resulting in a range of clinical manifestations. Understanding the clinical presentation and effective management strategies is crucial for healthcare professionals in providing timely and appropriate care to individuals with pneumothorax.
Clinical Manifestations:
Clinical Manifestations:
01:08Pneumothorax II: Pathophysiology
Pneumothorax means the presence of air in the pleural space — the thin potential gap between the visceral and parietal pleura. This condition disrupts the normal pressure balance that keeps the lungs inflated, leading to partial or complete collapse of the affected lung.Normal physiologyUnder normal conditions, the pleural space maintains a slightly negative intrapleural pressure, which keeps the lungs expanded against the chest wall. This negative pressure creates a delicate balance between...
01:24Flail Chest-I
Overview of Flail Chest
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
01:17The Thoracic Cage: Sternum
The thoracic or rib cage forms the body's thorax (chest) portion. Its primary function in the body is to protect vital organs in the thoracic cavity, such as the heart and the lungs. It consists of 12 pairs of ribs with their costal cartilages and the sternum. The ribs are anchored posteriorly to the 12 thoracic vertebrae (T1-T12).
The sternum is the elongated bony structure on the anterior side of the thoracic cage. It consists of three parts: the manubrium, the body, and the xiphoid process.
The sternum is the elongated bony structure on the anterior side of the thoracic cage. It consists of three parts: the manubrium, the body, and the xiphoid process.