Emergency Chest Decompression

Question 1

What are the indications for emergency chest decompression?

Answer 1

1. Traumatic cardiac arrest (with torso involvement)
2. Suspected tension pneumothorax with respiratory and / or haemodynamic compromise:

Respiratory - chest pain, dyspnoe, tachypnea, surgical emphysema, diminished breath sounds on affected side, tracheal deviation, cyanosis

Cardiovascular - tachycardia, ALOC, hypotension, JVD

Question 2

What are the contraindications for emergency chest decompression?

Answer 2

1. Obvious non-survivable injury in the traumatic cardiac arrest
2. For pneumodart - patients less than 50kg (14 years old)

Question 3

Complications of emergency chest decompression?

Answer 3

1. Improper diagnosis and insertion of a pleural catheter may lead to the creation of a simple pneumothorax or tension pneumothorax
2. Incorrect placement may result in life-threatening injury to the heart, great vessels or damage to the lung
3. Bilateral pleural decompression in the spontaneously breathing patient may result in significant respiratory compromise

Question 4

What is the procedure for emergency chest decompression?

Answer 4

1. Apply infection control measures
2. Identify appropriate insertion site (2nd intercostal space, midclavicular line)
3. Swab site
4. Stabilise chest wall by applying gentle tension on the skin
5. With dominant hand insert pneumodart/catheter perpendicular to the patients back along the superior border of the 3rd rib, to avoid the inferior neurovascular bundle
6. Listen for release of air
7. Count depth markers & secure in place with tape (consider stabilising with an umbilical cord clamp)
8. Re-evaluate breath sounds & haemodynamic status