1MEDICAL A thoracostomy is the process of a small incision made in the wall of the human chest along with the maintenance of drainage opening. This is the most common treatment procedure used for pneumothorax. Physicians and paramedics generally perform these tests usually with a needle thoracostomy technique. Higher access to the pleural space is observed in the case of this technique than tube thoracostomy and needle thoracostomy. However, thoracostomy has always been confused with thoracotomy, which is a process in which a larger incision is made within the chest wall to gain access to chest organs. According to recent research studies made in this field, finger thoracostomy is a process of alternative needlethoracostomyfortheemergenceofdecompressionassociatedwithatension pneumothorax (Arunan and Roodenburg 2017). However, there are various risks and benefits of using this procedure in intensive care. According to Menzieset al.(2018) tension pneumothorax is one of the potentially dangerous however reversible disorders which is associated with traumatic cardiac chest arrest. Needle decompression is a standard treatment, which used in pre hospitals in Ireland. Finger thoracostomy has is a process that has its effectiveness due t body habitus and anatomy.Internationally,paramedicdeliveredthoracostomyhasbeenobservedasa commonplace in the critical care services of hospitals. This paper clearly described the benefits of finger thoracostomy over needle thoracostomy. These advantages (benefits) are appropriate signs for pleura access, lesser chances of catheter kinking and no generation of new pneumothorax since puncturing of lung parenchyma are avoided by this procedure. The most important advantages of this procedure are the signs of pleural access as stated earlier (High, Brywczynski and Guillamondegui 2016). These signs include puncturing sensation of parietal pleura with the finger, feeling the lung parenchyma with finger and palpation of parietal pleura with the help of finger. Altogether, these factors are the most essential benefits of the process of finger thoracostomy. In Ireland, the paramedic group of MCI medical team
2MEDICAL is a multidisciplinary team, which uses this technique to treat major trauma and to perform pre-hospital anesthesia for these patients. This paper also stated that the introduction of paramedic delivered thoracostomy has been observed as effective and a feasible technique required for the process of tension pneumothorax treatment associated with a closely governed system. This paper described the factors of benefits very clearly, however, it failed to describe the risk factors. There are various types of risks associated with the procedure of this technique that is further described by other research studies. AccordingtoSnoek,ButsonandWittenberg(2016)chestdrainandfinger thoracostomy stay a contradictory topic in the field of medical science. This paper discusses the risks of using finger thoracostomy. The process of finger thoracostomy is slower to perform than the process of needle decompression. During finger thoracostomy, more number of steps are required for needle decompression. There are no tubes that hold the tract open, thus there is always a chance of sealing off during the resuscitation or transport process. According to this paper, there is an ongoing debate regarding the technique of formal intercostal drain when finger thoracostomy is advocated as an alternative in a patient (ventilated). Various advantages and disadvantages exist for the comparison between the placement of chest drain and finger thoracostomy decompression (Menzieset al.2018). The process of chest drain placement requires higher clinical expertise required to perform. This expertise is not required to perform the process of finger thoracostomy and can also be performed by paramedical professionals. However, finger thoracostomy does not allow much blood collection required to facilitate accurate estimation of the loss of blood. This study also states that a primary trauma condition of the chest uses finger thoracostomy as the process of treatment. Significant chest trauma treatment is also performed by finger thoracostomy by the London helicopter emergency service. However, for the cases involving the oxygenation in spontaneously ventilating patients, drainage of chest remains a better alternative. Thus, it can
3MEDICAL be stated that these are the overall risk factors of the process of finger thoracostomy by paramedical professionals in intensive care. According to Jodie and Kerstin (2017) finger, thoracostomy is used in various prehospital settings for patients who have problems with spontaneous breathing with a response which concerns the effectiveness of needle thoracostomy. The authors of this paper identified a significant factor for the treatment of patients with finger thoracostomy. The study includedpatientswith decreasedbreathsounds, serialribfractures, alongwith instabilities of chest walls. The authors found that for patients with various signs of above- stated symptoms showed a lesser mortality rate after being treated with finger thoracostomy. However,itwasfoundthatunreliablesignsof tensionwereassociatedwithtension pneumothoraxassociatedwithasignificantinjury.Thus,itcanbestatedthatthe determinationofpneumothoraxischallengingforothertechniquesapartfromfinger thoracostomy. This paper clearly described the benefits of finger thoracostomy over needle thoracostomy. These advantages (benefits) are appropriate signs for pleura access, lesser chances of catheter kinking and no generation of new pneumothorax since puncturing of lung parenchyma is avoided by this procedure (Menzieset al.2018). The most important advantages of this procedure are the signs of pleural access as stated earlier. There are various studies which stated that the effectiveness and safety of finger thoracostomy are of significant importance for non-medical personnel. All these observations were made form a case study concerning a 23-year-old male who was sitting unbelted in the driver's seat. Rapid ATLS examsrevealedthatthepatientrequiredathoracostomyforasuspectedtension pneumothorax. According to these authors, the alternative to needle thoracostomy (finger thoracostomy) is stated to be effective in treating the conditions of chest trauma. According to Dicksonet al.(2018) finger, thoracostomy has been used in prehospital medicine where complications with tube thoracostomy are observed. Finger thoracostomy is
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4MEDICAL one of the most rational approaches which is used in prehospital settings. The process uses an incision at intercostal space with a blunt finger dissection and clamps penetration in order to reach the pleural space. The most significant benefit of this process is that a repeat three sixty-degree finger sweep can be used to check for the in setting reaccumulation of any decompensation post-procedure. This advantage has also been observed in many other research articles which states that a simultaneous repeat process can be performed in order to check the process of accumulation. This technique has also been used in many emergency medical services that use simple thoracostomy for a traumatic cardiac arrest (Terbovenet al. 2019). This paper also stated that finger thoracostomy has decreased the mortality rates caused by chest trauma and blunt trauma. Thus, it can be concluded that the above-stated literature works state that finger thoracostomy is mostly a beneficial procedure for the treatment of chest trauma and cardiac arrest. Higher access to the pleural space is observed in the case of this technique than tube thoracostomy and needle thoracostomy. However, the risks of using the finger thoracostomy technique lie in the fact that there are no tubes that hold the tract open, thus there is always a chance of sealing off during the resuscitation or transport process. A better future can be hoped to provided the process of finger thoracostomy technique is improved from its present state.
5MEDICAL References Arunan,Y.andRoodenburg,B.,2017.Chesttrauma.Anaesthesia&IntensiveCare Medicine,18(8), pp.390-394. Dickson, R.L., Gleisberg, G., Aiken, M., Crocker, K., Patrick, C., Nichols, T., Mason, C. and Fioretti, J., 2018. Emergency Medical Services Simple Thoracostomy for Traumatic Cardiac Arrest:PostimplementationExperienceinaGround-basedSuburban/RuralEmergency Medical Services Agency.The Journal of emergency medicine,55(3), pp.366-371. High,K.,Brywczynski,J.andGuillamondegui,O.,2016.Safetyandefficacyof Thoracostomy in the Air Medical Environment.Air medical journal,35(4), pp.227-230. Jodie, P. and Kerstin, H., 2017. BET 2: Pre-hospital finger thoracostomy in patients with chest trauma.Emerg Med J,34(6), pp.419-419. Menzies, D., O'Neill, S., Leonard, J., Butcher, P., Creevy, P. and Irwin, D., 2018. Advanced Paramedic Delivered Finger Thoracostomy.Irish Journal of Paramedicine,3(2). Snoek, S., Butson, B. and Wittenberg, M., 2016. A challenging penetrating trauma case.Air medical journal,35(2), pp.88-92. Terboven, T., Leonhard, G., Wessel, L., Viergutz, T., Rudolph, M., Schöler, M., Weis, M. and Haubenreisser, H., 2019. Chest wall thickness and depth to vital structures in paediatric patients–implicationsforprehospitalneedledecompressionoftension pneumothorax.Scandinavianjournaloftrauma,resuscitationandemergency medicine,27(1), p.45.