ADDITIONAL SKILLS NOT FOR SALE OR DISTRIBUTION ...samples.jbpub.com/9780763779306/additionalSkills/Decompression of... · Tension pneumothorax is an accumulation of air or . gas in

1© 2012 Jones & Bartlett Learning, LLC (www.jblearning.com)

Knowledge Objectives1. Define tension pneumothorax. (p 2)

2. List some possible indicators that a tension pneumothorax is present. (p 2)

3. Describe the procedure for performing needle decompres-sion of a tension pneumothorax. (p 2)

Skills Objectives1. Demonstrate how to decompress a tension pneumothorax.

(pp 2–3, Skill Drill 1)

Contents

■ Decompression of a Tension Pneumothorax Skill Drill 1

ADDITIONAL SKILLS

Decompression of a Tension Pneumothorax

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2 Decompression of a Tension Pneumothorax

© 2012 Jones & Bartlett Learning, LLC (www.jblearning.com)

7. Insert the needle at a 90° angle, and listen for the release of air Step 5 . Be sure to insert it just superior to the third rib, midclavicular, or just above the sixth rib, midaxillary. (The nerves, arteries, and veins run along the inferior borders of each rib.)

8. Advance the catheter over the needle, and place the needle in the sharps container Step 6 .

9. Secure the catheter in place in the same manner you would use to secure an impaled object Step 7 .

10. Monitor the patient closely for recurrence of the ten-sion pneumothorax. This procedure may need to be repeated several times before arrival at the emergency department.

Consider analgesics for pain relief according to local pro-tocol, and consider sodium bicarbonate to offset metabolic acidosis in traumatic asphyxia. Follow local protocols or con-tact medical control as needed.

The performance of a needle decompression is not with-out risk. If the needle is improperly placed (ie, not inserted over the top of the rib), injury to the intercostal vessels may result in significant hemorrhage. Similarly, passing the needle into the chest may injure the lung parenchyma. Failure to treat this condition will cause the patient to progress to pulse-less electrical activity and cardiopulmonary arrest.

6Introduction

A tension pneumothorax is an accumulation of air or gas in the pleural space that progressively collapses the lung. It can occur with blunt or penetrating trauma, is immediately life threatening, and can be fatal. Pathophysiology and assess-ment findings are discussed in Chapter 28, Chest Injuries.

6Management

As mentioned in Chapter 28, Chest Injuries, management of a tension pneumothorax includes providing airway and ventilatory support, providing positive-pressure ventila-tions as needed, relieving tension to improve cardiac output, occluding open wounds, and calling for paramedic backup if needed. Needle decompression, also called needle thora-centesis, is the procedure used to relieve the tension, and is performed as described in Skill Drill 1 :

1. Assess the patient to ensure that the presentation is caused by a tension pneumothorax Step 1 : – Difficult ventilation despite an open airway – Jugular venous distention (may not be present with

associated hemorrhage) – Absent or decreased breath sounds on the affected

side – Hyperresonance to percussion on the affected side – Tracheal deviation away from the affected side

(remember that this a late sign and may not be present)

2. Obtain orders from medical control.

3. Obtain and assemble necessary equipment Step 2 : – Large-bore IV catheter, preferably 10- to 14-gauge

at least 2≤ long – Alcohol or povidone iodine (Betadine) preps – Cut off one finger of a glove to use as a substitute

if you do not have a commercial device or condom available.

– Adhesive tape 4. Make a one-way valve, or flutter valve, by inserting

the catheter through the end of a condom or use a commercially prepared device or the finger of a medi-cal glove, cut off from the glove.

5. Locate the appropriate site Figure 1 Step 3 . Find the second or third intercostal space in the midcla-vicular line on the affected side. If there is significant trauma to the anterior portion of the chest, use the intercostal space between the fourth or fifth ribs at the midaxillary line on the affected side. However, the midclavicular line approach is preferred because it is usually easier to access with less chance of dislodging the needle.

6. Cleanse the appropriate area using aseptic technique Step 4 .





















Decompression of a Tension Pneumothorax 3


Skill Drill 1

Decompression of a Tension Pneumothorax

Step 1 Assess the patient. Obtain orders from medical control.

Step 2 Obtain and assemble necessary equipment. Make a one-way flutter valve.

Step 3 Locate the appropri-ate site between the second and third rib.

Step 4 Cleanse the appropri-ate area using an aseptic technique.

Step 5 Insert the needle at a 90° angle.

Step 6 Remove the needle and listen for release of air. Properly dispose of the needle in the sharps container.

Step 7 Secure the catheter in place. Monitor the patient closely for recurrence of the tension pneu-mothorax.





















Prep Kit


6Ready for Review

■ Tension pneumothorax is an accumulation of air or gas in the pleural space that progressively collapses the lung. It is immediately life threatening.

■ Management of a tension pneumothorax includes pro-viding airway and ventilatory support, providing posi-tive-pressure ventilations as needed, relieving tension to improve cardiac output, occluding open wounds, and calling for paramedic backup if needed.

■ Needle decompression involves identifying the proper place for insertion (usually the second or third inter-costal space), making a flutter valve, and then inserting a needle into the space. You should hear the release of air. The catheter is then advanced over the needle and secured.

■ This procedure may need to be repeated several times before arrival at the emergency department.

■ Consider analgesics for pain relief according to local protocol.

6Vital Vocabulary

flutter valve A one-way valve that allows air to leave the chest cavity but not return. Formed by taping three sides of an occlusive dressing to the chest wall, leaving the fourth side open as the valve.

tension pneumothorax An accumulation of air or gas in the pleural space that progressively collapses the lung with potentially fatal results.

CreditsUnless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, LLC, courtesy of Mary-land Institute for Emergency Medical Services Systems, or have been provided by the American Academy of Orthopaedic Surgeons.





















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