Survival Medicine Series: Treating Tension Pneumothorax

DISCLAIMER: The information contained in this thread is not intended to replace advice from your family medical physician. It is intended to be used in a true worst case scenario, and should only be attempted when medical care is not available, and then only under the supervision of a trained professional (ie: EMT, Paramedic, RN, etc.).

I commonly browse threads in this forum relating to weaponry, food, shelter, but have yet to see any truly comprehensive discussion of emergency and survival medicine. Before continuing, please read the disclaimer and understand that some of the topics discussed in this series are advanced level medical procedures, and should be treated as such. Reading this topic will NOT make you proficient in their practice, and it is suggested that you take an advanced first aid class or EMT class. As with anything, practice fosters proficiency. In any case, please use this information responsibly!

During an emergency (see, complete SHTF/breakdown of society), you will likely encounter a wide variety of injuries ranging from simple sprains and cuts to complex fractures and trauma. A number of these conditions will requirement immediate intervention to correct and reduce overall morbidity. In this series, I will address numerous conditions and their proper treatment.

After reading this, if you think I've left anything out, please feel free to add it to the thread. I will then gladly ad d it to this post. Thanks!

Now, lets get started! Today, we will be focusing on treating an injury known as the Tension Pneumothorax.

Tension Pneumothorax

A pneuomothorax is a true medical emergency that should be expected during any type of mass-disaster. If left untreated, this condition will result in death, as patients are incapable of tolerating this injury for more than a day or two.

According to Medscape, a tension pneumothorax is defined as "a life-threatening condition that develops when air is trapped in the pleural cavity under positive pressure, displacing mediastinal structures and compromising cardiopulmonary function." The result is a collapse of the lung on the affected side, and decrease in cardiac function. This simply means that in the space between your lung and chest wall, there is an accumulation of air which is preventing the lung from fully inflating and is placing pressure on the portion of your body containing the heart. This air may enter by several different routes, but we will be focusing on air that enters the chest wall through a traumatic injury (such as a stab wound, or injury to the lung).

Diagnosis

While there are numerous tests required for an in-hospital diagnosis of this condition (CT scan, ultrasound, etc), a field diagnosis can be made when the patient has recieved a traumatic chest injury AND:

1) The patient exhibits signs of severe hypoxia (cyanosis-gray or bluish color to the skin and lips, low oxygen saturation levels shown with the use of a pulse oximeter-can be purchased for $30-$50) despite the administration of supplemental oxygen (should be a medication on everyone's survival list).

2) The patient has a rapidly deteriorating blood pressure (hypotension-general defined as a blood pressure lower than 100/systolic).

3) They exhibit signs of confusion.

Treatment

While the treatment is an invasive proceedure, it is routinely peformed by emergency medical personnel in a pre-hospital setting. With a working knowledge of human anatomy, and basic medical skills, you will be able to perform a life-saving intervention known as an emergency thoracic decompression or needle thoracostomy.

1) On the injured side of the chest, locate the space between the second and third rib (known as the second intercostal space) and insert a 14-gauge IV catheter (can be purchased for

Just having an open thoracentesis will leave you with a pneumothorax. If you're not just aspirating and then withdrawing the catheter, you'll want a flutter valve on the end.

If you don't have one, you can make do with some tubing and a jar of water.

First of all I HATE needles and that one was as big as pencil so I think I would like to take plan B, and if there isn't a plan B then so be it..........I fear not death hehehe

I had one done on me in an emergency situation years ago. I still have the scar. If you are conscious, it hurts like hell. It's like being stabbed... oh wait, you ARE being stabbed. So make sure the "recipient" is restrained if not unconscious. I am, obviously, still here and still breathing, so it was worth it.

This is a risky procedure to be perfectly honest. If done incorrectly it can cause more problems including more damage to the lungs, other organs or underlying tissue.

This method will work (kind Of) for non punctured tension pneumothorax such as a chest impact where no obvious signs of an open chest injury (hole/wound) are present.

If there is a wound, i.e. stab/gunshot etc then the best way forward would be to use a chest seal such as an Asherman Chest Seal or HyFin Chest Seal to seal the damage, before applying one of these and if the patient is concious - ask them to take a deep breath. If you don't have or fancy using one of these then you can use a Vaseline gauze dressing and tape it over the wound but ONLY on 3 sides.

If using a needle catheter with a flash chamber, you should ensure that the chamber is removed. There are specially manufactured needles designed just for a tension pneumothorax. These are pre-packaged 3.25 inch 14 gauge needles that do not have flash chambers. It has been reported that often the provider will forget to remove the flash chamber, and this will cause the procedure to fail and put the patient through a lot of pain for nothing.

A needle decompression should only be performed if the patient has a tension pneumothorax (Make sure that all checks have been completed, including 'chest sounds or osculation' using a stethoscope). When inserting the needle, it should be inserted at a 90 degree angle to the chest wall. This is a critical point as this will position the needle straight into the pleural space. If any other angle is used, there may be a chance of hitting other structures in the area such as major blood vessels or even the heart. Also bare in mind that this may not always be isolated to one lung, we can function on one lung so think before you go sticking a long pointy object into someone else's chest cavity.

Before anything is inserted into the chest cavity. ensure that everything is sterile using either alcohol wipes or providine/Iodine wipes. The last thing you want is to ease the pneumothorax but give them an infection that would lead to septicaemia.

As with any surgical procedure, only attempt it if you can complete it and always be prepared for the unexpected. This is a method that can and has gone horribly wrong so as the disclaimer from the OP says, use at you own risk!

Regards
Chris
Emergency Medical Technician

Thanks for the great information, Chris. I definetely should have elaborated on the use of a one way valve, but was primarily focusing on removing the catheter after insertion for the simple fact that the individual would probably need to be on the move.

However, after thinking about it, I wonder if there is a viable way to transport a person while leaving the cath in place? I suppose in pre-hospital care, we are never faced with having to make the patient ambulate following this procedure....which I think would likely be the case in a survival situation.

Great food for thought! And once again, thank you for the valuable information everyone.

I think that if a catheter was to be placed into the chest I would be inclined to try be keep the patient immobile for as long as possible or at least until the symptoms have passed. With something like this, close monitoring would definitely be required. Leaving the cath in place and the patient moving around could have disastrous results. If staying put is not an option then maybe using the catheter to release the pressure followed by a chest seal to cover the cath site may be the best way forward. I have not tried this method so again use at your own risk but I see no reason why it wouldn't work.

Please do not try and get the patient to move around too much with the catheter in place, puncture, clear and seal would be a better way to approach this I would say.

Nice thread though buddy