Shock Trauma Air Rescue Service, Calgary, Alberta, Canada.
Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
Air Med J. 2021 May-Jun;40(3):182-184. doi: 10.1016/j.amj.2021.01.001. Epub 2021 Feb 8.
This case highlights the novel use of endotracheal tubes to maintain patency of simple thoracostomies (STs) performed to relieve a tension pneumothorax after failed needle thoracostomy (NT). Treatment of a tension pneumothorax in the prehospital setting is typically performed using NT because of the minimal equipment required and rapid application. However, the variable efficacy of NT has led to a rise in the use of ST as an alternative procedure to treat a tension pneumothorax. A potential complication of ST is the occlusion of the thoracostomy site, which, left unresolved, may lead to the reoccurrence of tension physiology. In a resource-rich setting, such as in a hospital, the ST would be followed by tube thoracostomy to ensure patency. Unfortunately, this may not be feasible in prehospital environments where constraints exist because of time, equipment, and personnel. A review of the literature surrounding prehospital ST reveals previous reports of endotracheal tubes being used to maintain patency temporarily. However, no cases documenting the successful use of this novel procedure in an air medical setting were found at the time of writing. This case documents the successful use of this novel procedure during the treatment of a polytraumatized adult female resulting from a motorcycle crash.
本病例强调了在针式胸腔穿刺术（NT）失败后，使用气管内管来维持单纯性胸腔造口术（ST）通畅的新方法，以缓解张力性气胸。在院前环境中，通常使用 NT 来治疗张力性气胸，因为所需设备最少，且应用迅速。然而，NT 的疗效不一，导致 ST 作为替代程序治疗张力性气胸的使用有所增加。ST 的一个潜在并发症是胸腔造口部位的阻塞，如果不解决，可能会导致张力生理再次发生。在资源丰富的环境中，如医院，ST 之后会进行胸腔管引流以确保通畅。不幸的是，在院前环境中可能无法实现这一点，因为时间、设备和人员等方面存在限制。对院前 ST 相关文献的回顾表明，先前有报告称使用气管内管来临时维持通畅。然而，在撰写本文时，并未发现有关在航空医疗环境中成功使用这种新方法的案例。本病例记录了在治疗一名因摩托车事故导致多发伤的成年女性时成功使用这种新方法的情况。
