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Hohenberger, GM; Schwarz, A; Hohenberger, F; Niernberger, T; Krassnig, R; Hörlesberger, N; Weiglein, AH; Matzi, V.
Evaluation of Monaldi's approach with regard to needle decompression of the tension pneumothorax-A cadaver study.
Injury. 2017; 48(9):1888-1894
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Autor/innen der Med Uni Graz:
Hohenberger Gloria
Hörlesberger Nina
Krassnig Renate
Schwarz Angelika
Weiglein Andreas
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Abstract:
Although needle decompression of tension pneumothorax through the second intercostal space in the midclavicular line (Monaldi's approach) is a life-saving procedure, severe complications have been reported after its implementation. We evaluated the procedure by comparing how it was performed on cadavers by study participants with different training levels. Six participants including one thoracic surgeon performed bilateral thoracic drainage after Monaldi on 82 torsos. After the thoraces were opened, the distances from the internal thoracic artery (A), the site of the puncture (B) and the midclavicular line (C) were measured bilaterally with reference to the median of the sternum. Further, it was determined whether the participants had correctly identified the second intercostal space. The differences between B-A and C-B were analysed. The needle was placed in the second intercostal space in 136 hemithoraces (83%). The thoracic surgeon showed a hit rate of 0% laceration of adjacent vessels. All the other participants had hit rates between 10% and 15%. The interval B-A ranged from 2.88 to 5.06cm in right and from 3.00 to 5.00cm in left hemithoraces. The distance C-B lay between 1.03cm and 1.87cm (right side), and 0.84cm and 2.02cm (left side). In our collective, the main problem was failure to assess correctly the lateral extension of the clavicle. If this fact is emphasized during training, Monaldi's approach is a safe method for needle decompression of pneumothorax. Copyright © 2017 Elsevier Ltd. All rights reserved.
Find related publications in this database (using NLM MeSH Indexing)
Anatomic Landmarks -
Cadaver -
Clinical Competence -
Decompression, Surgical - education
Decompression, Surgical - instrumentation
Decompression, Surgical - methods
Education, Medical, Continuing -
Emergency Medicine - education
Humans -
Pneumothorax - surgery
Simulation Training -
Thoracic Wall - anatomy & histology
Thoracic Wall - surgery
Thoracostomy - education
Thoracostomy - methods

Find related publications in this database (Keywords)
Tension pneumothorax
Needle decompression
Monaldi's approach
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