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J Korean Soc Emerg Med > Volume 27(5); 2016 > Article
Journal of The Korean Society of Emergency Medicine 2016;27(5): 396-403.
흉부 외상 환자를 대상으로 한 바늘흉강감압술 도관의 길이 및 삽입 위치에 대한 연구
공민규, 김현종, 박준석, 김경환, 신동운, 김 훈, 박준민, 전우찬
인제대학교 일산백병원 응급의학과
Evaluation of the Optimal Site and Needle Length of Needle Thoracostomy in Chest Trauma Patients
Mingyu Kong, Hyunjong Kim, Junseok Park, Kyung Hwan Kim, Dongwun Shin, Hoon Kim, Joon Min Park, Woochan Jeon
Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
Correspondence  Hyunjong Kim ,Tel: 031-910-7944, Fax: 031-910-7188, Email: drkim@paik.ac.kr,
Received: June 15, 2016; Revised: June 16, 2016   Accepted: July 15, 2016.  Published online: October 30, 2016.
ABSTRACT
Purpose:
Tension pneumothorax is a life threatening condition. As an emergency treatment, needle thoracostomy with 50mm angiocatheter at the second intercostal space on the mid-clavicular line (2nd ICS/MCL) is recommended in the current guidelines. However, another site has been suggested in some studies. The purpose of this study was to determine whether the current procedure should be changed, by comparing the chest wall thicknesses (CWT) at the 2nd ICS/MCL and the 5th ICS/AAL (anterior axillary line) of injured patients.
Method:
A retrospective observational study was performed in an emergency center between May 2009 and December 2011. Medical records and computed tomography (CT) images of 140 included patients were reviewed. CWT at the 2nd ICS/MCL was compared with the 5th ICS/AAL. Moreover, the relationship between BMI (body mass index) and CWT was evaluated.
Results:
CWT of the 2nd ICS/MCL was 31.7±8.5 mm on the right and 31.6±8.8 mm on the left, with no differences (p=0.42). CWT of the 5th ICS/AAL was 28.1±8.5 mm on the right and 27.8±7.7 mm on the left, also with no differences (p=0.30). CWT of the 2nd ICS/MCL was thicker than that of the 5th ICS/AAL (p<0.001). Nevertheless, CWT of all sites were not thicker than 50 mm (p<0.001). BMI was positively correlated with CWT.
Conclusion:
There was insufficient amount of evidences shown in this study to change the current guidelines of needle thoracostomy. However, in case of obvious patients, a long needle and 5th ICS/AAL site should be considered for needle thoracostomy, because CWT tended to increase as BMI increased.
Key words: Chest injury, Needle thoracostomy, Tension pneumothorax
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