This is for informational purposes and does not replace proper training.
If you patient develops a tension pneumothorax, he will need to have the
air trapped inside his chest cavity removed before it collapses one or
Locate the third intercostal space, between the 4th and 5th ribs,
Clean the affected side or sides. Under dire circumstances I've seen this
skipped many times. Its easier to treat an infection later then let
someone die right now.
Betadine works well for this. Use one to scrub the area and the second to
clean from the inside of the site to the outside.
There are several different techniques and tools available for this. The
simplest and most likely available is a large IV angio. A 3 inch long 14
gauge (orange) is best but 16 gauge (gray) will also work. It needs to be
longer then the normal IV angio since it must pass through the muscle, fat
and other matter before it can reach the lung.
Insert the angio at a 90 degree angle till you hear air escaping. Then
advance the catheter into the site, and remove the needle. If you have a
NACL syringe, first attach it to the angio and you will see it bubble when
you have reached the proper depth. Advance catheter only and remove the
syringe. If you hit a rib, go over the top of the rib and not below to not
damage the neuro-vascular bundle.
With the angio in place you can either use a premade kit with a 4 way stop
cock or you can improvise. The hole made by the angio is very small
compared to the trachea. Even if the person did not have a tension
pneumothorax you would only cause a minor pneumo which many people suffer
from without adverse affect.
If you do not have a premade kit, you can occlude the catheter by
inserting the IV through a glove finger first. Lay the glove finger over
the angio hole. When the patient breaths in, the finger will occlude the
hole. If air builds up it will force past the glove.