April 19, 2021

Background: Tension Pneumothorax (TP) can occur as a potentially life-threatening complication of chest trauma. With the risk of respiratory and cardiac arrest, an immediate temporizing intervention for this condition is required by direct Needle Decompression (ND). In 2018, the Advanced Trauma Life Support (ATLS) recommendations changed from the 2nd intercostal space in the midclavicular line (ICS2-MCL) to the 4th/5th intercostal space just anterior to the anterior-axillary line (ICS4/5-AAL), whereas the European Trauma Course (ETC) trauma guidelines and the guidelines from the Royal College of Surgeons of Edinburgh (RCSEd) in the UK still adhere to placement in the ICS2-MCL for the preferred location of ND. Both chest wall thickness of the patient and needle length both play a role in the success rate of ND.  Although it is well known that Chest Wall Thickness (CWT) increases with BMI, it is unknown if the optimal place for ND may vary with BMI.

March 3, 2021

Background: One of the most common reasons for Emergency Department (ED) visits is chest pain. While most of these presentations are at a low risk for cardiac events, it is generally required to perform a full work-up to rule out an Acute Coronary Syndrome (ACS), including an Acute Myocardial Infarction (AMI), before being discharged responsibly. The biggest challenge for physicians is to not only identify patients who are likely to have ACS but also to identify low risk patients that can be safely discharged without prolonged stays for further investigation. The current standard of practice, including risk assessment protocols, recommend using serial troponin testing and detection of absolute changes in troponin levels to rule out AMI in the ED. Recent studies using high sensitivity troponin (hsTnT) have shown that if the initial troponin is very low, one troponin may be sufficient to safely discharge patients from the ED, especially when combined with the HEART score. In practice however, in countries where hsTnT is not generally available, some clinicians have adopted this strategy using conventional troponin. This particular practice of using single conventional troponin testing has not been studied well.