title: Safety and Efficacy of Thoracostomy in the Air Medical Environment.
abstract: OBJECTIVE
  The use of thoracostomy to treat tension pneumothorax is a core skill for prehospital providers. Tension pneumothoraces are potentially lethal and are often encountered in the prehospital environment.
  
  
  METHODS
  The authors reviewed the prehospital electronic medical records of patients who had undergone finger thoracostomy (FT) or tube thoracostomy (TT) while under the care of air medical crewmembers. Demographic data were obtained along with survival and complications.
  
  
  RESULTS
  During the 90-month data period, 250 patients (18 years of age or older) underwent FT/TT, with a total of 421 procedures performed. The mean age of patients was 44.8 years, with 78.4% being male and 21.6% being female; 98.4% of patients had traumatic injuries. Cardiopulmonary resuscitation was required in 65.2% of patients undergoing FT/TT; 34.8% did not require cardiopulmonary resuscitation. Thirty percent of patients exhibited clinical improvement such as increasing systolic blood pressure, oxygen saturation, improved lung compliance, or a release of blood or air under tension. Patients who experienced complications such as tube dislodgement or empyema made up 3.4% of the cohort.
  
  
  CONCLUSIONS
  The results of this study suggest that flight crews can use FT/TT in their practice on patients with actual or potential pneumothoraces with limited complications and generate clinical improvement in a subset of patients.
authors.affiliation: Department of Emergency Medicine, Vanderbilt Medical Center, Nashville, TN. Electronic address: kevin.high@vanderbilt.edu.
authors.forename: Kevin
authors.initials: K
authors.lastname: High
authors.affiliation: Department of Emergency Medicine, Vanderbilt Medical Center, Nashville, TN.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Brywczynski
authors.affiliation: Division of Trauma and Surgical Critical Care, Vanderbilt Medical Center, Nasville, TN.
authors.forename: Oscar
authors.initials: O
authors.lastname: Guillamondegui
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017732:Air Ambulances; D016887:Cardiopulmonary Resuscitation; D015505:Chest Tubes; D004653:Empyema / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D013907:Thoracostomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*; D055815:Young Adult