To relieve tension pneumonthorax.
- May occur in the setting of chest trauma, COPD, PPV, spontaneously
- Consider among (H’s and T’s) in cardiac arrest. Particularly in the setting of penetrating traumatic arrest.
Signs and symptoms include:
- Clinical evidence of a pneumothorax
- Absent or decreased unilateral breath sounds.
Other less sensitive signs include:
- Asymmetrical chest movement with inspiration
- Hyper-expanded chest on affected side
- Drum like percussion on affected side
- Increased resistance to positive pressure ventilation, especially if intubated
- Evidence of tension physiology
- Hemodynamic instability: shock or rapidly decreasing blood pressure
- Elevate head of stretcher to 30 degrees.
- Expose the entire chest.
Identify the second intercostal space midclavicular on the side of the pneumothorax.
- Place finger on the clavicle at its midpoint.
- Run this finger straight down the chest wall to locate the first palpable rib between the clavicle.
- The second intercostal space lies just below this rib, midway between the clavicle and the nipple line.
Alternatively, identify the 4th or 5th intercostal space, anterior-axillary line. (Preferred location in patients with larger chest size)
- Raise arm above and over head.
- Identify the edge of the pectoralis muscle. (anterior axillary line)
The nipple line or inferior-most border of axillary hair typically represents the 4th intercostal space.
- Consider that the nipple may be displaced inferiorly in female patients, may not correlate with the 4th ICS.
- Cleanse the area with an alcohol or povidone-iodine swab.
- Select a 10, 12, or 14 gauge (at least) 3" IV catheter (Pediatric: 16 gauge, 1 ¼ inch).
- Advance the needle above the rib. (blood vessels and nerves run along the underside of the rib.)
- As you enter the pleural space, you will feel a pop and note a rush of air expelling.
- Advance the catheter into the chest and then withdraw the needle. Be careful not to kink the catheter.
- Auscultate breath sounds.
- Secure with gauze and tape.
- Ventilate and monitor ETCO2.
- If symptoms fail to improve, consider the site alternate to initial attempted (above), contact Online medical control
- for further guidance.
- Hemodynamic and respiratory stability