References

Allison K, Porter K, Mason A Use of the Asherman chest seal as a stabilisation device for needle thoracostomy. EMJ. 2002; 19:(6)590-1

Bartolomeo S, Sanson G, Nardi G A Population-Based Study on Pneumothorax in Severely Traumatized Patients. The Journal of Trauma. 2001; 51:(4)677-82

Barton E, Epperson M, Hoyt B Prehospital needle aspiration and tube thoracostomy in trauma victims: a six-year experience with aeromedical crews. The Journal of Emergency Medicine. 1995; 13:(2)155-63

Barton E Tension pneumothorax. Current Opinion in Pulmonary Medicine. 1999; 5:(4)269-82

Butler K, Best I, Weaver W Pulmonary Artery Injury and Cardiac Tamponade after Needle Decompression of a Suspected Tension Pneumothorax. The Journal of Trauma. 2003; 54:(3)610-611

Chan S Tension Pneumothorax Managed Without Immediate Needle Decompression. The Journal of Emergency Medicine. 2009; 36:(3)242-5

Cullinane D, Morris J, Bass J Needle thoracostomy may not be indicated in the trauma patient. Injury. 2001; 32:(10)749-52

Deakin C Letters to the Editor. The Journal of Trauma. 1998; 44:(6)

Heng K, Bystrzycki A, Fitzgerald M Complications of intercostal catheter insertion using EMST techniques for chest trauma. Australia & New Zealand. Journal of Surgery. 2004; 74:(6)420-423

Joint Royal Colleges Ambulance Liaison Committee. 2006. http//tinyurl.com/2dp6psg

Jones R, Hollingsworth J Tension pneumothorax not responding to needle thoracocentesis. EMJ. 2002; 19:(2)176-77

Lee C, Revell M, Porter K The prehospital management of chest injuries: a consensus statement. Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh. EMJ. 2007; 24:(3)220-4

Leigh-Smith S, Davies G Tension pneumothorax: eyes may be more diagnostic than ears. EMJ. 2003; 20:(5)495-6

Leigh-Smith S, Harris T Tension pneumothorax – time for a re-think?. EMJ. 2005; 22:(1)8-16

Leigh-Smith S Tension pneumothorax prevalence grossly exaggerated. EMJ. 2007; 24:(12)865-7

Lockey D Prehospital thoracostomy. European Journal of Emergency Medicine. 2008; 15:(5)283-5

Massarutti D, Trillo G, Berlot G Simple thoracostomy in prehospital trauma management is safe and effective: a 2-year experience by helicopter emergency medical crews. European Journal of Emergency Medicine. 2006; 13:276-80

McRoberts R, McKechnie M, Leigh-Smith S Tension pneumothorax and the ‘forbidden CXR’. EMJ. 2005; 22:(8)597-8

Netto F ‘Are needle decompressions for tension pneumothoraces being performed appropriately for appropriate indications?’. The American Journal of Emergency Medicine. 2008; 26:(5)597-602

Schmidt U, Stalp M, Gerich T Chest Tube Decompression of Blunt Chest Injuries by Physicians in the Field: Effectiveness and Complications. The Journal of Trauma: Injury, Infection and Critical Care. 1998; 44:(1)98-100

Watts B, Howell M Tension Pneumothorax: a difficult diagnosis. EMJ. 2001; 18:(4)319-20

Waydhas C, Sauerland S Prehospital pleural decompression and chest tube placement after blunt trauma: A systematic review. Resuscitation. 2007; 72:(1)11-25

Tension pneumothorax: are prehospital guidelines safe and what are the alternatives?

04 February 2011
Features
02 February 2011
Volume 3 · Issue 2

Abstract

Tension pneumothorax is a life-threatening complication of chest injury. It can cause rapid physiological decompensation, cardiac arrest and death. The Joint Royal Colleges Ambulance Liason Committee (JRCALC) provide guidelines on the prehospital diagnosis and treatment of this condition. The aim of this article is to ask whether or not these guidelines are effective and if there are feasible alternatives to the management of tension pneumothoraces in the prehospital environment.

This article discusses recent literature regarding the prehospital treatment of tension pneumothorax. The obstacles involved in diagnosing the condition are considered, along with the techniques to treat it. Is current paramedic practice in dealing with the condition providing safe and effective care for patients and are there feasible prehospital alternatives?

Tension pneumothorax (TPNX) is an immediately life-threatening thoracic injury (Leigh-Smith and Davies, 2003). It occurs when a one way valve is created between the lung and the pleura. This leads to a build up of air in the pleural cavity during each respiratory cycle resulting in an increase in intrathoracic pressure.

Eventually the lung on the injured side collapses and the mediastinum is displaced towards the opposite side. Venous return is compromized and cardiac arrest can follow (Watts and Howell, 2001).

The JRCALC (2006) guidelines emphasize the possible need for rapid therapeutic action, with Leigh-Smith and Davies (2003) in agreement that if the clinical signs suggest a TPNX, then rapid treatment is required.

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Decompression
Pneumothorax
Thoracocentesis
Thoracostomy