Clinical Appraisal of Needle Thoracostomy in a Canadian Aeromedical System

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dc.contributor.advisorLaing, Catherine
dc.contributor.advisorReay, Gudrun
dc.contributor.authorNewton, Graham
dc.contributor.committeememberKing-Shier, Kathryn
dc.contributor.committeememberMageau, Alexis
dc.contributor.committeememberLang, Eddy
dc.date2022-06
dc.date.accessioned2022-04-05T17:12:05Z
dc.date.available2022-04-05T17:12:05Z
dc.date.issued2022-03
dc.description.abstractBackground: Needle thoracostomy (NT) remains the standard for prehospital treatment of tension pneumothorax, but its effectiveness has been questioned in previous literature. The incidence of NT and clinical characteristics of patients receiving NT for tension pneumothorax in a Canadian helicopter emergency medical service (HEMS) setting have yet to be described. This lack of data leads to difficulty understanding who is at greatest risk for requiring NT, identifying factors that may be important to successful clinical outcomes, and implementing changes to practice. Methods: A retrospective chart review was conducted of adult patients who received NT from a Canadian HEMS service and a case study was conducted to document the novel use of an endotracheal tube to perform an improvised tube thoracostomy in response to NT failure. Results: Only a small proportion (1.3%) of patients attended by the HEMS service received NT during their care. The study sample was predominantly male (77.0%), with an average age of 46.4 years, and a presenting complaint of blunt trauma. Logistic regression analysis revealed initial NT treatment was associated with a low likelihood of clinical improvement in patients presenting with blunt trauma (OR = 0.18; p = .021), receiving CPR prior to NT (OR = 0.14; p = .02), or in those who received bilateral NT treatment (OR = 0.13; p < .01). A pre-treatment BP < 90 mmHg was the sole variable which was predictive of a positive clinical response to initial NT (OR = 3.33; p = .04). The case study provided a descriptive account of the successful use of a simple thoracostomy in combination with endotracheal tube insertion into the thorax to relieve tension pneumothorax following the failure of standard NT treatment in the HEMS setting. Conclusions: Of the patients studied, those most likely to receive NT were males who had suffered blunt trauma. NT may have questionable benefit for patients presenting with blunt trauma, cardiac arrest, or requiring bilateral NT. NT may be insufficient to adequately treat tension pneumothorax, and simple thoracostomy with thoracic endotracheal tube insertion has been successfully used to treat tension pneumothorax refractory to standard prehospital treatment.en_US
dc.identifier.citationNewton, G. (2022). Clinical appraisal of needle thoracostomy in a Canadian aeromedical system (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.en_US
dc.identifier.doihttp://dx.doi.org/10.11575/PRISM/39675
dc.identifier.urihttp://hdl.handle.net/1880/114533
dc.language.isoengen_US
dc.publisher.facultyNursingen_US
dc.publisher.institutionUniversity of Calgaryen
dc.rightsUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.en_US
dc.subjectadulten_US
dc.subjectair ambulanceen_US
dc.subjecthelicopteren_US
dc.subjectEmergency Medical Servicesen_US
dc.subjectpneumothoraxen_US
dc.subjectprehospitalen_US
dc.subjectretrospective studiesen_US
dc.subjectthoracostomyen_US
dc.subject.classificationBiophysics--Medicalen_US
dc.subject.classificationHealth Sciencesen_US
dc.subject.classificationNursingen_US
dc.titleClinical Appraisal of Needle Thoracostomy in a Canadian Aeromedical Systemen_US
dc.typemaster thesisen_US
thesis.degree.disciplineNursingen_US
thesis.degree.grantorUniversity of Calgaryen_US
thesis.degree.nameMaster of Nursing (MN)en_US
ucalgary.item.requestcopytrueen_US
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