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Invited Critique
Sep 2012

The Death of Another Sacred Cow: Comment on “Radiologic Evaluation of Alternative Sites for Needle Decompression of Tension Pneumothorax”

Author Affiliations

Author Affiliations: Division of Trauma, Critical Care & Acute Care Surgery, Oregon Health & Science University, Portland, Oregon.

Arch Surg. 2012;147(9):818-819. doi:10.1001/archsurg.2012.759

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.

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