Needle decompression, also known as needle thoracostomy, is the procedure in which a needle is inserted into a patient’s chest with the intent of relieving a suspected or confirmed tension pneumothorax.
Pneumothorax and sucking chest wound
A sucking chest wound is created when a patient sustains a penetrating injury that breaches the chest wall and creates an opening greater than 1/3 the diameter of the trachea. As the patient attempts to breathe and their diaphragm contracts, air is drawn in through this opening. Sucking chest wounds are commonly treated with occlusive dressings or chest seals with one-way valves.
A pneumothorax by definition is air within the thorax, specifically air that is outside of the lung space. Pneumothoraxes come in several varieties: simple pneumothorax, traumatic pneumothorax, and tension pneumothorax.
Simple pneumothorax
[Simple Pneumothorax Image] (Fig 1)
A simple, or spontaneous, pneumothorax (Figure 1) is a condition in which abnormalities and weaknesses in the lung parenchyma undergo a rupture which allows air from the lung to enter the of the thoracic cavity. Patients who are tall and thin tend to have higher incidences of spontaneous pneumothorax, which may occur while undergoing strenuous activity. Patients with simple pneumothoraxes rarely progress to tension pneumothorax and are generally not able to be treated by EMS providers with a needle decompression.
Traumatic pneumothorax
[Traumatic Pneumothorax image] (Fig 2)
A traumatic pneumothorax (Figure 2) forms from the progression of a sucking chest wound or from trauma to the lung tissue itself. A traumatic pneumothorax may progress to a tension pneumothorax and as such should be treated by EMS to prevent worsening of the patient’s condition. A traumatic pneumothorax with no signs of tension pneumothorax should be treated with an occlusive dressing or chest seal with one-way valve.
Hemo- vs pneumo- (thorax) (Fig 3)
[Hemothorax image]
A hemothorax (Figure 3) is a condition in which blood, instead of air, enters the thoracic cavity. This can occur after a traumatic event and can cause the same complications as a pneumothorax.
Tension pneumothorax (Fig 4)
[Tension Pneumothorax image]
A tension pneumothorax (Figure 4) is characterized by significant pressure intrapleural on a collapsed lung which forces that lung against the heart and great vessels. This type of pneumothorax is a life threat as it can easily cause obstructive shock by impeding normal cardiac function and/or venous return. A tension pneumothorax may be treated by needle decompression. Patients with a tension pneumothorax may present with shortness of breath, tachycardia, hypotension and unilateral lung sounds among other findings. A late sign of tension pneumothorax is a deviation of the trachea to the opposite side of the affected lung.
