Page 195 - 2023 SMOG Digital

NEEDLE THORACOSTOMY

CLINICAL INDICATIONS:
Suspect a tension pneumothorax and treat when a casualty has significant torso trauma or primary blast
injury and one or more of the following:
• Severe or progressive respiratory distress or tachypnea, absent or markedly decreased breath sounds on one
side of the chest, chest pain, distended neck vessels, hemoglobin oxygen saturation <90% on pulse oximetry,
shock, traumatic cardiac arrest without obviously fatal wounds
* Note: If not treated promptly, tension pneumothorax may progress from respiratory distress to shock and traumatic cardiac
arrest.
CONTRAINDICATIONS:
• None
PROCEDURE: Note: This intervention is a BRIEF stopgap utilized in order to buy time for a definitive tube
thoracostomy. It is not a solution unto itself.
• Decompress the chest on the side of the injury with a 14-gauge or a 10-gauge, 3.25-inch needle/catheter.
• If a casualty has significant torso trauma or primary blast injury and is in traumatic cardiac arrest: decompress both
sides of the chest before discontinuing treatment. Clean area if possible with betadine / alcohol, but do not delay
treatment for this step.
Note: Either the 5th intercostal space (ICS) in the anterior axillary line (AAL) or the 2nd ICS in the mid-clavicular line (MCL)
may be used for needle decompression (NDC.) If the anterior (MCL) site is used, do not insert the needle medial to the
nipple line.
• The needle/catheter unit should be inserted at an angle perpendicular to the chest wall and just over the top of the
lower rib at the insertion site. Insert the needle/catheter unit all the way to the hub and hold it in place for 5-10
seconds to allow decompression to occur.
• After the NDC has been performed, remove the needle and leave the catheter in place.
• The NDC should be considered successful if:
Respiratory distress improves; there is an obvious hissing sound as air escapes from the chest when
o
NDC is performed (this may be difficult to appreciate in high-noise environments); hemoglobin oxygen
saturation increases to 90% or greater (note that this may take several minutes and may not happen at
altitude); casualty with no vital signs has return of consciousness and/or radial pulse.
• If the initial NDC was successful, but symptoms later recur:
Perform another NDC at the same site that was used previously. Use a new needle/catheter unit for the
o
repeat NDC.
• If the second NDC is also not successful:
o Fix appropriate circulation issues and consider finger/tube thoracostomy.
Document procedure, results, and vital signs.

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