Tension Pneumothorax, Treatment

Treatment of a tension pneumothorax includes immediate needle decompression. The patient is placed in a supine position, the head of the bed is elevated 30 degrees, and an 18- to 20-gauge over-the-needle catheter (angiocatheter) is inserted into the second intercostal space just over the top of the third rib at the midclavicular line. Ideally, a 5- to 10-mL syringe should be attached to the angiocatheter. The syringe is aspirated gently as the needle is advanced. A loss of resistance or a rush of air will be apparent as soon as the pleural space is entered. If pneumothorax is confirmed, a one-way drainage device should be attached. The respiratory distress should improve markedly when the pneumothorax is decompressed. This procedure should not be delayed for a confirmatory chest radiograph because rapid deterioration is likely. A chest tube should be placed after successful needle decompression.

References:
American Heart Association, American Academy of Pediatrics. Airway and ventilation. In: Chameides L, Hazinski MF, eds. Pediatric Advanced Life Support. Dallas, Tex: American Heart Association; 1997:4-1–4-22
Connors KM, Terndrup TE. Tube thoracostomy and needle decompression of the chest. In: Henretig FM, King CK, eds. Textbook of Pediatric Emergency Procedures. Baltimore, Md: Williams & Wilkins; 1997:389-407