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Description: Thoughts by the EMT: "The paradigm for chest decompression (treatment for tension pneumo/hemothroax) is shifting. . . HISTORY: 1. Needle decompression with 14/16g angio cath 2nd intercostal space (ICS) midclavicular = classic teaching and most widely known. 2. More efficacious location of 5th ICS anterior-axillary line (if in scope of practice, primary location I teach my medics). Increased proper location, treatment, and decreased chances of tube kinks/inadequate depth. . 3. Now, finger thoracostomy 5th ICS and bypass any NDC. . . I no longer will reach for an NDC if I have available space/time for a finger thoracostomy. All I need is my finger, scalpel or kelly. . NOTE: Tension pneumo is a clinical dx (classic hypotension, JVD, tracheal deviation). Imaging does include ultrasound and cxr or CT options, but life threatening cases should be treated BEFORE imaging. The finger thoracostomy allows quick access to the pleura and allows me to continue on with my primary / secondary trauma surveys. THEN go back and place a chest tube. The chest tube itself does NOT save the patient. It's the evacuation of air/blood that is the life-threat. . . There is discussion of this procedure prehospital. But is not mainstream. There are studies available . DO NOT attempt these procedures if you are not formally trained, in scope of practice and in your local guidelines."