Dr Matt Sztajnkrycer, MD
Director of EM Fellowship
Fellowship Program Director
Professor, Emergency
Medicine Medical director, Rochester Fire Department, Rochester Police Department, Olmsted County Sheriff’s Office
Tactical physician, Rochester Police Department, Olmsted County Sheriff’s Office Emergency Response Unit
Physician, TF-MN1 Urban Search and Rescue team
Medical school: University of Connecticut School of Medicine
Ph.D.: University of Connecticut Graduate School
Residency: University of Cincinnati College of Medicine
Fellowship: University of Cincinnati College of Medicine, Toxicology and Hyperbaric Medicine
Niche: Prehospital/EMS Medicine, Disaster Medicine, Acute and Intensive Care Toxicology
Interests: Operational and high threat medicine, emergency preparedness
NAEMSP Breakfast Discussion Topic
Recent Advances in the Diagnosis and Management of Tension Pneumothorax
Rapid diagnosis and decompression of tension pneumothorax is foundational in the management of chest trauma. Military studies indicate that as many as 33% of all possibly preventable combat deaths are attributable to tension pneumothorax. Historically, decompression of tension pneumothorax involved insertion of a 14 gauge 1.75” angiocatheter in the 2nd intercostal space, mid-clavicular line. However, several studies suggested that this route and catheter size were associated with high rates of complication and failure.
The purpose of this presentation is to review recent peer-reviewed publications evaluating the need for needle decompression and the consequences of delayed management, alternative locations for needle decompression, complications associated with different anatomic approaches, and the rationale for finger thoracostomy rather than needle decompression in specific cases.
Learner Objectives
- Review the physiology of tension pneumothorax
- Discuss the literature surrounding needle decompression failure and complications
- Describe anatomic landmarks for 5th intercostal space anterior axillary line decompression
- Discuss the advantages and disadvantages of finger thoracostomy
