Tension Pneumothorax

Question 1

What is a pneumothorax/tension pneumothorax?

Answer 1

The build up of fluid or air within the pleural space. As the pressure builds, the pleural space can collapse the lung, displace the mediastinum and obstruct venous return to the heart, leading to compromised cardiopulmonary function and potentially cardiac arrest.

Question 2

What are the signs/symptoms of a tension pneumothorax?

Answer 2

RESPIRATORY
Chest pain, dyspnoea, tachypnoea, surgical emphysema, diminished breath sounds on affected side, trachael deviation & cyanosis

CARDIOVASCULAR
Tachycardia, ALOC, hypotension, JVD (rare), distended veins in neck

Question 3

What are the indications for emergency chest decompression?

Answer 3

1. Traumatic cardiac arrest with torso involvement
2. Suspected tension pneumothorax with respiratory and/or haemodynamic compromise

Question 4

Describe the appropriate needle insertion site.

Answer 4

The 2nd intercostal space, midclavicular line of affected side. Needle should be inserted perpendicular to the patient’s back along the superior border of the 3rd rib.

Question 5

When is the Pneumodart preferred?

Answer 5

For use in patients greater than 50kg (~14 years +)

Question 6

What gauge cannula do you use for patients under 50kg or 14yrs?

Answer 6

15-50kg (~4-14yrs) = 14g (45mm)
<15kg (3yrs and under) = 16g (30mm)