Tension Pneumothorax: Next-Step Management When Needle Thoracocentesis Has Not Worked
Clinical scenario
This protocol addresses confirmed tension pneumothorax in which the initial emergency decompression attempt has failed to relieve the condition — specifically when immediate air release and the expected improvement in clinical parameters were not achieved.
Previous treatment — failure condition that triggers this protocol
Needle thoracocentesis (mid axillary approach, 5th intercostal space) was performed but did not achieve its required goals: immediate release of air and improvement in clinical parameters. Non-achievement of these targets is the defined escalation criterion to this next line of management.
Next-step approach (partial)
Escalation involves a chest tube procedure on the confirmed side of the tension pneumothorax, using a specific intercostal approach and a particular insertion technique. Correct function of the drainage setup is confirmed by observing a characteristic sign in the apparatus — the complete step-by-step protocol, including technique details and success criteria, is available via the link below.
References
- A chest tube must then be placed in the 5th intercostal space on the side of the confirmed tension pneumothorax using the Seldinger type when possible.
- Make sure the underwater drain seal apparatus is oscillating and bubbling.
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