Review Note
Last Update: 02/27/2025 04:46 AM
Current Deck: ACG Part 2::Thoracic SSU
New Card (Unpublished)Currently Published Content
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Front
Commit #291103SS_TS 1.22 Discuss the diagnosis and management of:
• Pneumothorax/tension pneumothorax:
Back
Commit #291103- Tension pneumothorax is a life threatening condition
- Hypoxia, tachypnoea, hypotension, decreased breath sounds with hyper-responance on affected side, tracheal deviation away from affected side and elevated CVP
- Clinical signs as above + CXR (but don’t delay treatment)
- Treat: Needle decompression -> insert chest drain
- Needle thoracocentesis:
- 14G cannula or alternative needle decompression (e.g. TPAK chest decompression needle)
- Alcohol swab (2% chlorhexidine gluconate in 70% isopropyl)
- Syringe (10ml)
- Non-sterile gloves
- Sharps bin
- Surgical tape or other methods of securing the cannula
- Clean procedure tray (unlikely to be available in pre-hospital settings)
- Paeds: Neonate / small infant (age 0-4): 24 – 22G
- Age 5: 20G / 3.2cm needle
- Age 10: 18G / 4.5cm needle
- 2x possible insertion sites: 2nd intercostal space, midclavicular line or 5th intercostal space mid-axillary line.
- 2nd intercostal space:
- Locate the suprasternal notch and move your fingers to the angle of Louis which sits on the 2nd rib
- From the angle of Louis move your fingers to the side of the sternum of the injury and feel the gap in the rib, this is the 2nd intercostal space.
- Run your fingers along this gap and align them with the middle of the clavicle. This is the mid-clavicular region of the 2nd intercostal space.
- Insertion should be superior to the third rib border to avoid nerves, arteries and veins that pass here.
- 5th intercostal space:
- Abduct the patient’s arm on the affected side to allow a view of the axilla.
- Insertion should take place within the triangle of safety identified using the landmarks; lateral border of Pectoralis major, anterior border of Latissimus dorsi, superior 5th intercostal space.
- Run your fingers along the gap anterior to the mid-axillary line.
- Space should be identified as superior to the 6th rib
- Procedure:
1. Examine the chest and confirm clinical findings of tension pneumothorax
- Identify the correct side of the chest for insertion
2. Clean the insertion site on the affected side with an alcohol swab
3. Remove the cannula sheath
4. Prepare cannula
- Open the cannula wings if present
- Slightly withdraw and replace the needle (this will allow it to glide more easily)
- Unscrew the cap at the back of the cannula and attach a 10ml syringe
5. Insert 14g cannula at 90o into the insertion site. Insert through the chest wall structures towards the pleural space
- Withdraw the plunger of the syringe until air or fluid aspirates from the cannula.
6. Advance the cannula whilst removing the introducer needle and the syringe
7. Dispose of the introducer needle into the sharp container
8. Secure the cannula in place with tape to prevent it becoming dislodged
9. Confirm success with auscultation