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European Journal of Trauma and Emergency Surgery

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26-10-2022 | Ultrasound | Original Article

Point-of-care ultrasound thoracic “Quick Look” identifies potentially dangerous chest tube insertion sites

Authors: Russell Lieurance, Mark Scheatzle, William A. Johnjulio, John O’Neill

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2023

Abstract

Purpose

Emergency and trauma physicians typically rely on anatomic landmarks to determine the proper intercostal space for emergent tube thoracostomy. However, physicians using this technique select a potentially dangerous insertion site too inferior in nearly one-third of cases, which have the potential to result in subdiaphragmatic puncture. We investigated a point-of-care ultrasound (POCUS) thoracic “Quick Look” procedure as a technique to allow visualization of underlying structures to avoid tube misplacement.

Methods

We performed an observational study of adult emergency department patients and their treating physicians. The patient’s emergency physician was asked to rapidly identify and mark a hypothetical tube thoracostomy insertion site on the patient’s chest wall. An ultrasound fellow then performed a POCUS thoracic “Quick Look” exam with a phased-array probe placed directly over the marked site. Over one regular respiratory cycle, the identification of standard lung pattern was considered a negative scan whereas visualization of the diaphragm with underlying liver or spleen was considered a positive scan. Time for completion of the “Quick Look” scan was measured and inter-rater reliability was determined through image review by a single, blinded ultrasound director.

Results

Seventy-six thoracic “Quick Look” scans were performed on patient subjects, of which 17% (13/76, 95%CI 8–26%) were positive. The average time for performing the “Quick Look” exam was 43 s (95%CI 30–57). Inter-rater reliability of the thoracic “Quick Look” was excellent (κ = 0.95).

Conclusion

Thoracic “Quick Look” exams performed at mock chest tube insertion sites demonstrated potentially dangerous insertions in 17% of the cases. POCUS thoracic “Quick Look” may be a rapid and reliable technique that improves safety when placing an emergent chest tube.

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Title: Point-of-care ultrasound thoracic “Quick Look” identifies potentially dangerous chest tube insertion sites
Authors: Russell Lieurance
Mark Scheatzle
William A. Johnjulio
John O’Neill
Publication date: 26-10-2022
Publisher: Springer Berlin Heidelberg
Keywords: Ultrasound
Pneumothorax
Pneumothorax
Pneumothorax
Care
Ultrasound
Published in: European Journal of Trauma and Emergency Surgery / Issue 2/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-02109-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Point-of-care ultrasound thoracic “Quick Look” identifies potentially dangerous chest tube insertion sites

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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