Pleural Decompression

Indications:

1. Tension pneumothorax (EMS provider MUST be able to recognize this!)

2. Traumatic cardiac arrest

Identify the site locations:

• 2nd intercostal space in the mid-clavicular line on the affected side(s).

• 4th/5th intercostal space on the anterior axillary line on the affected side(s) (preferred site)

• 4th/5th intercostal space mid-axillary line on the affected side(s) (If blocked by blood and not getting good decompression move to anterior site)

  1. Clean site with an alcohol swab, if this will not unduly delay the procedure. 

  2. Insert the decompression needle in the 4th-5th intercostal space in the anterior axillary line, inserting at a 45 degree angle in a cranial direction over the rib (preferred site) Insert a decompression needle OVER the insertion site until an escape of air is obtained. Remove the needle, leaving the catheter in place. 

  3. Secure the catheter in place.

  4. Monitor respiratory status.