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EMERGENCY DEPARTMENT · WALL POSTER

Finger Thoracostomy

STEPS  ·  ◆ KEY STEP — LOGGED WITH ITS TIME
FINGER THORACOSTOMY — IN ARREST THIS IS THE WHOLE PROCEDURE
  1. Arm abducted. 5th intercostal space, anterior to the mid-axillary line, at nipple level.
  2. 4–5 cm transverse incision through skin and subcutaneous tissue.
  3. Blunt dissect over the top of the rib with a clamp, then push through the pleura.
  4. Sweep a full gloved finger 360° — lung, clot, diaphragm. Feel for a hole. ◆ FINGER IN — PLEURA SWEPT
  5. Do the other side in traumatic arrest.
  6. Re-finger if tension physiology recurs.
  7. Massive blood out on either side → consider thoracotomy.
FIGURE
Go in over the top of the rib, inside the triangle — never below the nipple line without imaging.