PDF(Pubmed)
Abstract：
Introduction Tension pneumothorax is an immediate threat to life. Treatment in the prehospital setting is usually achieved by needle thoracostomy (NT). Prehospital personnel are taught to perform NT, frequently in the second intercostal space (ICS) at the mid-clavicular line (MCL). Previous literature has suggested that emergency physicians have difficulty identifying this anatomic location correctly. We hypothesized that paramedics would also have difficulty accurately identifying the proper location for NT. Methods A prospective, observational study was performed to assess paramedic ability to identify the location for treatment with NT. Participants were recruited during a statewide Emergency Medical Services (EMS) conference. Subjects were asked the anatomic site for NT and asked to mark the site on a shirtless male volunteer. The site was copied onto a transparent sheet lined up against predetermined points on the volunteer\'s chest. It was then compared against the correct location that had been identified using palpation, measuring tape, and ultrasound. Results 29 paramedics participated, with 24 (83%) in practice for more than five years and 23 (79%) doing mostly or all 9-1-1 response. All subjects (100%) reported training in NT, although six (21%) had never performed a NT in the field. Nine paramedics (31%) recognized the second ICS at the MCL as the desired site for NT, with 12 (41%) specifying only the second ICS, 11 (38%) specifying second or third ICS, and six (21%) naming a different location (third, fourth, or fifth ICS). None (0%) of the 29 paramedics identified the exact second ICS MCL on the volunteer. Mean distance from the second ICS MCL was 1.37 cm (interquartile range (IQR): 0.7-1.90) in the medial-lateral direction and 2.43 cm in the superior-inferior direction (IQR: 1.10-3.70). Overall mean distance was 3.12 cm from the correct location (IQR: 1.90-4.50). Most commonly, the identified location was too inferior (93%). Allowing for a 2 cm radius from the correct position, eight (28%) approximated the correct placement. 25 (86%) were within a 5 cm radius. Conclusion In this study, paramedics had difficulty identifying the correct anatomic site for NT. EMS medical directors may need to rethink training or consider alternative techniques.
摘要：
引言张力性气胸是对生命的直接威胁。院前环境中的治疗通常通过针式胸廓造口术（NT）实现。院前人员被教导执行NT，经常在锁骨中线（MCL）的第二肋间空间（ICS）。以前的文献表明，急诊医生很难正确识别这种解剖位置。我们假设护理人员也很难准确确定NT的正确位置。方法A前瞻性，我们进行了观察性研究,以评估护理人员确定NT治疗部位的能力.参与者是在全州紧急医疗服务（EMS）会议期间招募的。向受试者询问NT的解剖部位，并要求在裸露的男性志愿者上标记该部位。将该站点复制到与志愿者胸前的预定点对齐的透明薄片上。然后将其与使用触诊确定的正确位置进行比较，卷尺,和超声波。结果29名护理人员参加，24（83％）在实践中超过5年，23（79％）进行大部分或全部9-1-1反应。所有受试者（100％）都报告了NT的训练，尽管有6人（21％）从未在该领域进行过NT。9名护理人员（31％）认为MCL的第二个ICS是NT的理想部位，12个(41%)只指定第二个ICS，11（38%）指定第二或第三ICS，和六个（21％）命名不同的位置（第三，第四,或第五ICS)。29名护理人员中没有人（0％）确定了志愿者的确切第二ICSMCL。与第二个ICSMCL的平均距离在内侧-外侧方向为1.37cm（四分位距（IQR）：0.7-1.90），在上下方向为2.43cm（IQR：1.10-3.70）。与正确位置的总平均距离为3.12cm(IQR:1.90-4.50)。最常见的是,确定的位置太差(93%)。允许距离正确位置2厘米的半径，八个(28%)接近正确的位置。25（86％）在5厘米半径内。结论在本研究中,护理人员难以确定NT的正确解剖部位.EMS医疗主管可能需要重新考虑培训或考虑替代技术。
