🧭 REBEL Rundown
📌 Key Points
- 🧠 Think Beyond Trauma: Don’t forget to suspect tension pneumothorax in ventilated patients who suddenly crash or after a central line placement! 🫁⚠️
- 🔍 Confirm with Ultrasound: If the patient is stable enough, grab the probe! 🖐️📟Ultrasound can rapidly confirm tension PTX and avoid unnecessary delays.
- 💉🚫 Needles Are Out: Needle decompression? Meh. Finger thoracostomy is faster, more reliable, and more definitive. 🖐️🫁
📝 Introduction
On this episode of the Rebel Core Cast, Swami takes a deep dive into pneumothorax decompression, focusing on the need for improvements beyond the classic teachings. Covering scenarios where immediate decompression is critical, particularly in tension pneumothorax, Swami discusses the limitations of needle decompression, especially in the second intercostal space at the midclavicular line. He highlights the importance of using POCUS for diagnosis and recommends skipping needle decompression in favor of finger thoracostomy for a more reliable and effective treatment. Key takeaways emphasize recognizing tension pneumothorax in various clinical situations and the advantages of finger thoracostomy over traditional techniques.
⏰ Highlights
- 00:00 Introduction to Pneumothorax Decompression
- 00:17 Recognizing Tension Pneumothorax
- 01:00 Common Scenarios for Pneumothorax
- 01:34 Confirming Diagnosis with POCUS
- 01:50 Issues with Needle Decompression
- 03:21 Advantages of Finger Thoracostomy
- 04:11 Key Takeaways and Conclusion
📚 References
- Ferrie EP et al. The right place in the right space? Awareness of site for needle thoracentesis. Emerg Med J 2005; 22: 788-9 PMID: 16244336
- Laan DV et al. Chest wall thickness and decompression failure: a systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Injury; 2016; 47(4): 797-804 PMID: 26724173
- Terboven T et al. Chest wall thickness and depth to vital structures in paediatric patients – implications for prehospital needle decompression of tension pneumothorax. Scan J Trauma Resusc Emerg Med 2109; 27(1). PMID: 30992028
Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_propersi), and Mark Ramzy, DO (X: @MRamzyDO)
👤 Associate Editor
🔎 Your Deep-Dive Starts Here
REBEL Core Cast 143.0–Ventilators Part 3: Oxygenation & Ventilation — Mastering the Balance on the Ventilator
When you take the airway, you take the wheel and ...
REBEL Core Cast 142.0–Ventilators Part 2: Simplifying Mechanical Ventilation – Most Common Ventilator Modes
Mechanical ventilation can feel overwhelming, especially when faced with a ...
REBEL Core Cast 141.0–Ventilators Part 1: Simplifying Mechanical Ventilation — Types of Breathes
For many medical residents, the ICU can feel like stepping ...
REBEL Core Cast 140.0: The Power and Limitations of Intraosseous Lines in Emergency Medicine
The sicker the patient, the more likely an IO line ...
REBEL Core Cast 137.0: A Simple Approach to Sinus Tachycardia
Sinus tachycardia is the most prevalent cardiac dysrhythmia in critically ...
REBEL Core Cast 136.0: A Simple Approach to the Tachypneic Patient
In this episode, we focus on the bedside evaluation of ...
