Author Affiliations: Division of Trauma, Critical Care & Acute Care Surgery, Oregon Health & Science University, Portland, Oregon.
Generations of advanced trauma life support students have been taught that placing a 5-cm needle in the fifth ICS at the MCL is one of the fastest and easiest ways to save the life of a patient with a tension pneumothorax. This article1 is another in a series of assaults by Dr Inaba and his colleagues on this very basic concept. In their previous work,2 Dr Inaba placed 5-cm needles in cadavers and then performed thoracotomies to see whether the needles entered the chest. They found that 100% of needles placed in the fifth ICS at the AAL entered the chest, while only 58% of needles placed in the second ICS at the MCL did so.
Schreiber MA. The Death of Another Sacred CowComment on “Radiologic Evaluation of Alternative Sites for Needle Decompression of Tension Pneumothorax”. Arch Surg. 2012;147(9):818-819. doi:10.1001/archsurg.2012.759