Needlessly Treated: Evaluation of Prehospital Needle Thoracostomy.

Autor:	Vazquez GE; Author Affiliations: Iowa Methodist Medical Center, UnityPoint Health, Des Moines, IA (Mr Vazquez, Dr Calhoun, Ms Fuchsen, and Drs Capella, Vaudt, Sidwell, Smith, Pelaez); University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA (Mr Vazquez); and The Iowa Clinic, Des Moines, IA (Drs Capella, Dr Sidwell and Dr Pelaez)., Calhoun JR, Fuchsen EA, Capella JM, Vaudt CC, Sidwell RA, Smith HL, Pelaez CA
Jazyk:	angličtina
Zdroj:	Journal of trauma nursing : the official journal of the Society of Trauma Nurses [J Trauma Nurs] 2024 Sep-Oct 01; Vol. 31 (5), pp. 242-248. Date of Electronic Publication: 2024 Sep 06.
DOI:	10.1097/JTN.0000000000000808
Abstrakt:	Background: Needle thoracostomy is a potentially life-saving intervention for tension pneumothorax but may be overused, potentially leading to unnecessary morbidity. Objective: To review prehospital needle thoracostomy indications, effectiveness, and adverse outcomes. Methods: A retrospective cohort study was conducted based on registry data for a United States Midwestern Level I trauma center for a 7.5-year period (January 2015 to May 2022). Included were patients who received prehospital needle thoracostomy and trauma activation before hospital arrival. The primary outcomes were correct indications and improvement in vital signs. Secondary outcomes were the need for chest tubes, correct needle placement, complications, and survival. Results: A total of n = 67 patients were reviewed, of which n = 63 (94%) received a prehospital thoracostomy. Of the 63 prehospital thoracostomies, 54 (86%) survived to arrival. Of these 54, 44 (n = 81%) had documented reduced/absent breath sounds, 15 (28%) hypotension, and 19 (35%) with difficulty breathing/ventilating. Only four patients met all three prehospital trauma life support criteria: hypotension, difficulty ventilating, and absent breath sounds. There were no significant changes in prehospital vitals before and after receiving needle thoracostomy. In patients receiving imaging (n = 54), there was evidence of 15 (28%) lung lacerations, 6 (11%) of which had a pneumothorax and 3 (5%) near misses of important structures. Review of needle catheters visible on computer tomography imaging found 11 outside the chest and 1 in the abdominal cavity. Conclusion: The study presents evidence of potential needle thoracostomy overuse and morbidity. Adherence to specific guidelines for needle decompression is needed. Competing Interests: No conflicts of interest to report. (Copyright © 2024 Society of Trauma Nurses.)
Databáze:	MEDLINE
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