EMERGENCY MEDICINE: DECOMPRESSION OF PNEUMOTHORAX

Pneumothorax simply means collapsed lungs. It is the collection of free air in the chest outside the lungs that causes the lungs to collapse.

This could either occur:

  • spontaneously(rupture of a cyst on the surface of the lungs)
  • From an underlying pathology(cystic fibrosis, lung cancer, asthma, chronic obstructive pulmonary disease)
  • From an injury to the lungs(fractured rib, gunshot, stabbing, surgical incision)

 

When a patient presents with sudden sharp chest pain, feeling of tight chest, tachycardia, shortness of breath, cough and fatigue suspect pneumothorax.

Treatment includes insertion of chest tube or aspiration of air from the chest cavity.

Needle decompression of tension pneumothorax is still taught as 2nd interclavicular space(ICS) at the mid-clavicular line although several studies have shown that this may be inadequate. In a study performed by 25 Navy Corpsmen, the misplacement rate at the 5th intercostal space(ICS) anterior axillary line was 22% while the misplacement rate at the 2nd intercostal space mid-clavicular line was 82%. The participants placed the needle closer to the target spot in the 5th ICS and rated it easier. However, when would decompression at this spot become the default spot?

REFERENCE:Lauren Westafer.

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Cynthia Isuekebhor