Indications: Suspect tension pneumothorax and critically ill or VSA and absent or severely diminished breath sounds on the affected side(s).
Needle Thoracostomy: If the patient is hypotensive or VSA patch to BHP for authorization to perform a needle thoracostomy.
Clinical Considerations: A needle thoracostomy may only be performed at the second intercostals space in the midclavicular line.
- Apply 100% O2. Auscultate the chest and confirm suspicion of tension pneumothorax.
- Contact the BHP for on-line medical direction to proceed with this protocol.
- If every attempt to contact a BHP has failed, the Advanced Care Paramedic may continue with this protocol in a life-threatening situation if all other indications and conditions are met. The paramedic should contact the BHP (and the BH) as soon as possible after the procedure and document the patch failure and decision to proceed.
- Locate the second intercostal space on the anterior chest wall in the midclavicular line on the affected side. Prep the area quickly.
- Insert a 14 gauge 2 inch catheter-over-needle attached to a syringe partly filled with saline along the upper border of the rib. Advance the catheter 1 to 2 inches while aspirating for free air.
- Remove the needle and syringe. There may be a rush of air out of the needle.
- Secure the catheter in place. The paramedic may attach a flutter valve or other device.