title: Needle decompression in appalachia do obese patients need longer needles?
abstract: BACKGROUND
  Needle decompression of a tension pneumothorax can be a lifesaving procedure. It requires an adequate needle length to reach the chest wall to rapidly remove air. With adult obesity exceeding one third of the United States population in 2010, we sought to evaluate the proper catheter length that may result in a successful needle decompression procedure. Advance Trauma Life Support (ATLS) currently recommends a 51 millimeter (mm) needle, while the needles stocked in our emergency department are 46 mm. Given the obesity rates of our patient population, we hypothesize these needles would not have a tolerable success rate of 90%.
  
  
  METHODS
  We retrospectively reviewed 91 patient records that had computed tomography of the chest and measured the chest wall depth at the second intercostal space bilaterally.
  
  
  RESULTS
  We found that 46 mm needles would only be successful in 52.7% of our patient population, yet the ATLS recommended length of 51 mm has a success rate of 64.8%. Therefore, using a 64 mm needle would be successful in 79% percent of our patient population.
  
  
  CONCLUSIONS
  Use of longer length needles for needle thoracostomy is essential given the extent of the nation's adult obesity population.
authors.affiliation: Southern Ohio Medical Center and Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio.
authors.forename: Thomas Edward
authors.initials: TE
authors.lastname: Carter
authors.affiliation: Southern Ohio Medical Center and Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio.
authors.forename: Curtis Dee
authors.initials: CD
authors.lastname: Mortensen
authors.affiliation: Southern Ohio Medical Center and Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio.
authors.forename: Salita
authors.initials: S
authors.lastname: Kaistha
authors.affiliation: Southern Ohio Medical Center and Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio.
authors.forename: Christopher
authors.initials: C
authors.lastname: Conrad
authors.affiliation: Ohio University Heritage College of Osteopathic Medicine, Research Office of the Centers for Osteopathic Research and Education, Athens, Ohio.
authors.forename: Godwin
authors.initials: G
authors.lastname: Dogbey