Ben Mays
Journal of Paramedic Practice, Vol. 8, Iss. 5, 06 May 2016, pp 258

In the absence of advanced
practitioners on scene, needle
thoracostomy (NT) is the
only treatment modality
currently widely available to
paramedics in order to relieve
tension pneumothorax. Both
ATLS and JRCALC guidelines
(Association of Ambulance
Chief Executives, 2013)
recommend that for NT, a
cannula be placed at the
second intercostal space at
the mid-clavicular line (ICS2-
MCL). This paper, however,
cites a number of difficulties
associated with NT at this site,
namely, variable chest wall
thickness (CWT) and inability
of practitioners to identify the
correct anatomical location.
Commonly used alternative
sites consist of the 4th/5th
intercostal space, mid axillary
line (ICS4/5- MAL) and 4th/5th
intercostal space, anterior
axillary line (ICS 4/5- AAL).

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