Chest Wall Thickness in Military Personnel: Implications for Needle Thoracentesis in Tension Pnemothorax

## COL H. Theodore Harcke, MC USA, COL H. Theodore Harcke, MC USA; LCDR Lisa A. Pearse, MC USN; COL Angela D. Levy, MC USA; John M. Getz, BS; CAPT Stephen R. Robinson, MC USN

Military Medicine, Vol. 172, December 2007

#### Description with Key Points:

Advanced Trauma Life Support guidelines and combat casualty care doctrine recommend the use of needle thoracentesis (needle thoracostomy) for the emergency treatment of tension pneumothorax. Emergency situations require a reproducible, simple, and effective normal response for treatment of life-threatening pneumothorax. This study evaluated chest wall thickness in a forward-deployed tri-service population using a retrospective analysis of multidetector CT (MDCT)-assisted autopsies performed on combat casualties at the Armed Forces Institute of Pathology.

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If needle thoracentesis is attempted with an angiocatheter or needle of insufficient length, the procedure will fail. Recommended procedures for needle thoracentesis to relieve tension pneumothorax should be adapted to reflect use of an angiocatheter or needle of sufficient length. A 3.25 inch angiocatheter would have reached the pleural space in 99% of the cases in this series.

Chest Wall Thickness in Military Personnel: Implications for Needle Thoracentesis in Tension Pneumothorax
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# Take Home Message:

Both lung function and heart function are impaired with a tension pneumothorax, causing respiratory distress and shock.
Treatment is to let the trapped air under pressure escape.
The recommended anatomic location to insert a needle thoracentesis catheter for emergency treatment of a pneumothorax is the second intercostal space at the midclavicular line.
When access to the second intercostals space midclavicular line is prevented by field conditions such as wound location,equipment, or position of the casualty, needle thoracentesis may need to be done at an adjacent location.
Several casualties died from needles being too short to get through the chest wall.
Previously used 2 inch needles were too short.
3.25 inch needles will get through the chest wall in 99% of individuals.