Tension pneumothorax – time to change the old mantra?

Here is your ATMIST handover in resus: 28 year old male, injured 25 minutes ago, penetrating chest trauma, Asherman seal on anterior chest, RR 35, clearly deteriorating, high flow O2 administered.Initial observations: A – moaning, distressed, mask fogging, B – RR is now more like 40, with reduced expansion on the right, and absent breath soundsAre his neck veins distended? Trachea deviated? You are swift, brave and decisive – in goes the 14G cannula, 2nd intercostal space, mid clavicular line and…nothing happens. In fact, the patient continues to deteriorate…What is your next option?Following the recent LITFL blog demonstrating a CT of a tension pneumothorax, we review some of the controversies in managing this much-maligned medical emergency.Tension pneumothorax describes the progressive accumulation of air in the pleural cavity (normally a potential space) through a defect in the visceral pleura. This leads to positive pressure being maintained and increasing throughout the respiratory cycle causing vessels within the mediastinum to be compressed with catastrophic consequences if left untreated. Clinical signs include hypoxia, hypotension, tachycardia, reduced breath sounds and hyper resonance ipsilaterally, with tracheal deviation (away from the affected side) and distended neck veins being late clinical signs.In treating a tension pneumothorax, we have traditionally been taught to place a large bore catheter in the second intercostal place (2nd ICS) mid...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Education Respiratory 2nd ICS 5th ICS Ian Duffus tension tension pneumothorax Source Type: blogs