Needle thoracentesis and needle cricothyroidotomy

Question 1

What are the clinical features of a tension pneumothorax?

Answer 1

Low sats on air
Ipsilateral chest movement
Absent breath sounds
Tachycardia
Distended neck veins (if no hypovolaemia)

Question 2

What are the steps to a needle chest decompression?

Answer 2

1. Mid clavicular line 2nd intercostal space
2. Remove cap and flashback chamber and attach syringe holding 2ml of air to fluid port
3. Clean site
4. Insert needle as far as possible at 90 degrees
5. IF air release not seen push the 2ml of air
6. Withdraw needle and hold cannula in place until secured down

Question 3

Why is a needle chest decompression done?

Answer 3

Removes air (or fluid) from the lung in from the plural space.

Question 4

What is the plural space?

Answer 4

Is the thin gap between the pleura of the lung and the inner chest wall.

Question 5

What is a tension pneumothorax?

Answer 5

A tension pneumothorax occurs when pleural damage allows more air into the pleural space during inspiration than escapes during expiration. This leads to a build-up of air in the pleural space with an increase in intrathoracic pressure. As a result, there is a further collapse of the lung and pushing of the diaphragm down, ribs outwards and mediastinum across to the other hemithorax.

Question 6

When should a needle cricothyroidotomy be considered?

Answer 6

The pt is unconscious
All other measures have failed

Question 7

What are the steps to a needle cric?

Answer 7

1. Blue call to hospital and pre alert requesting an anaesthetist
2. Locate cricothyroid membrane
3. Remove cap and flashback chamber from cannula and attach empty 10ml syringe.
4. Clean site
5. Insert cannula at a 45degree angle approx 1cm, aspirate with syringe to confirm placement.
6. Secure cannula