We're going over left lateral chest placement. Jen, can you show us how to get a good landmark?

 First, I want to come up and identify the patient's pectoralis muscle. I'm right-handed, so I'm using my non-dominant hand to grab his pectoralis muscle. My pointer finger, notice it finds directly where that rib is, and this happens to be the fifth intercostal space.

One of the big dangers that we're trying to avoid is, if I were to continue to bury my needle to the hub in this particular side, I would be hitting into that left ventricle of the heart.

Note: The distance from skin to pericardium for 75% of patients falls within the length of the recommended needle catheter unit (83-mm / 3.25-inch)  _{Thompson et al. Risk of Harm in Needle Decompression for Tension Pneumothorax, Journal of Special Operations Medicine."}

We opened up that option in the Department of Defense through the committee on TCCC to go to the left and right anterior axillary side. One of the issues is on the left side in particular, since your heart lays over on that side, it varies in people, right?

Note: Median skin to pericardium distance, 5th ICS AAL= 66mm (2.6in) with a range of 54mm (2.1in) to 70mm (3.1in)

Not everybody's the same. And so some can be within, you know, three, two, three inches from the side, especially in an older population, especially if there are some comorbidities. They may have that cardiac box that's right off the left side. So we don't want to over-penetrate on the left side.