Analysis of Risks and Benefits: Finger Thoracostomy in Medical Care

This report provides a comprehensive analysis of finger thoracostomy, a medical procedure primarily used in the treatment of chest trauma and tension pneumothorax. The report highlights the benefits of the procedure, such as improved access to the pleural space compared to tube thoracostomy and needle thoracostomy, and the reduced risk of catheter kinking. The report also emphasizes the importance of finger thoracostomy in prehospital settings, particularly in cases of traumatic cardiac arrest. However, the report also acknowledges the risks associated with the technique, including the absence of a tube to keep the tract open, which can lead to sealing off during resuscitation or transport. The study also compares finger thoracostomy with needle thoracostomy and other methods. The report draws on various research studies and case studies to support its findings, including studies that have investigated the effectiveness and safety of finger thoracostomy, the role of paramedics in performing the procedure, and the impact on patient outcomes. The report concludes that while finger thoracostomy is a beneficial procedure, improvements are needed to address its limitations and enhance patient safety.

Running head: MEDICAL
RISK AND BENEFITS OF IMPLEMENTING FINGER THORACOSTOMY
Name of the Student
Name of the University
Author Note

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
needle thoracostomy for the emergence of decompression associated with a tension
pneumothorax (Arunan and Roodenburg 2017). However, there are various risks and benefits
of using this procedure in intensive care.
According to Menzies et 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, paramedic delivered thoracostomy has been observed as a
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.
According to Snoek, Butson and Wittenberg (2016) chest drain and finger
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 (Menzies et 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 included patients with decreased breath sounds, serial rib fractures, along with
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, it was found that unreliable signs of tension were associated with tension
pneumothorax associated with a significant injury. Thus, it can be stated that the
determination of pneumothorax is challenging for other techniques apart from finger
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 (Menzies et 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
exams revealed that the patient required a thoracostomy for a suspected tension
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 Dickson et al. (2018) finger, thoracostomy has been used in prehospital
medicine where complications with tube thoracostomy are observed. Finger thoracostomy is

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 (Terboven et 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. and Roodenburg, B., 2017. Chest trauma. Anaesthesia & Intensive Care
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: Postimplementation Experience in a Ground-based Suburban/Rural Emergency
Medical Services Agency. The Journal of emergency medicine, 55(3), pp.366-371.
High, K., Brywczynski, J. and Guillamondegui, O., 2016. Safety and efficacy of
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–implications for prehospital needle decompression of tension
pneumothorax. Scandinavian journal of trauma, resuscitation and emergency
medicine, 27(1), p.45.