References
Clinical suspicion regarding needle decompression for patients with chest trauma
Abstract
Background:
Needle decompression of the chest is indicated for patients in a critical condition with rapid deterioration who have a life-threatening tension pneumothorax.
Aim:
To reassure UK prehospital care providers that needle decompression of the chest is not commonly required in chest trauma patients, and most can be safely managed without it.
Methods:
Case studies as part of a major trauma network continuous review process have revealed instances of needle decompression in the absence of tension pneumothorax. Images are presented where needle decompression was attempted in the absence of tension pneumothorax.
Context:
Expert opinion from our network's multidisciplinary trauma team discuss the occurrence of tension pneumothorax in self-ventilating patients, and the idea that tension pneumothorax is rare in the UK civilian trauma population is acknowledged. Other causes of chest hypoventilation are discussed.
You arrive on scene and, following a safety <C>ABCDE assessment, discover a 30-year-old conscious trauma victim who has suffered blunt trauma to the chest in a fall from a standing height onto a concrete bollard. Blood pressure is 140/84 mmHg; pulse is 96 beats per minute; and respiratory rate is 20 breaths per minute. The trachea is central and there is decreased chest movement and air entry on the side of the injury over an area of extreme tenderness. Oxygen saturations on air are 94%. Does this patient require needle decompression of their chest?
Needle decompression of the chest (also known as thoracocentesis or thoracentesis) is a manoeuvre to release abnormal air from the pleural space. Prehospital needle decompression is only indicated for patients suffering from tension pneumothorax; this is an accumulation of air under tension that displaces the mediastinum, causes diaphragmatic depression (and inversion), impaired venous return and respiratory compromise—and ultimately cardiac arrest. This is different from a simple pneumothorax where the air merely occupies the pleural space and there are no pressure effects. Tension pneumothorax is an uncommon event in UK civilian major trauma patients, and especially uncommon in the self-ventilating patient (Leigh-Smith and Harris, 2005).
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