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EMR
EMT
AEMT
Paramedic
Extended
Chest Decompression
Steps
Performed?
Yes No
1.
Assess for clinical indications
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Progressive severe respiratory distress and/or cyanosis
Hyperresonance on percussion of the affected area
Tracheal shift away from the affected side
Distended neck veins
Hypotension
Suddenly difficulty when attempting to ventilate the patient
Reduced or absent breath sounds over the affected lung
2.
Administer 100% Oxygen to patients with suspected tension pneumothorax
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3.
Expose entire chest area and clean the site vigorously with an antibacterial/antiseptic
wipe. Prepare large bore over-the-needle catheter, 14 gauge or larger (16-18 gauge for
children) with 10mL or larger syringe with 3-4 mL of fluid attached via PRN extension
set.
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4.
Insert catheter into the second intercostal space on the midclavicular line while
withdrawing the plunger of the syringe. Ensure that the needle slides over the top of the
third rib until it reaches the parietal space. Air bubbles will enter the syringe when the
needle is at the appropriate depth.
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5.
Once depth is confirmed, insert catheter and withdraw needle. If air is under tension, it
will exit under pressure.
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6.
If no air is obtained, leave the catheter in place with syringe attached, and secure.
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7.
With a simple or open pneumothorax that shows no signs of tension, needle
thoracentesis is of no value and may be harmful! Continuously reassess adequacy of
ventilation.
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8.
When possible, leave syringe attached to catheter via PRN adapter extension set and
secure the syringe to the patient’s chest. Withdraw air as needed to prevent further
tension pneumothoraces.
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Chest Decompression