Pneumothorax

Airway

  • Chin lift, jaw thrust, head tilt –> 14 gauge needle through cricothyroid membrane or surgical cricothyroidotomy with #5 or #6 tube)
  • Breathing (rate, rhythm, air entry, O2 sat)
  • Circulation

History:  ?accident, ?mechanism of injury

Physical:

  • Inspection – lack of chest movement, broken ribs, flail chest
  • Percussion – hyperresonant in pneumothorax, full in hemothorax, may have a pneumohemothorax
  • Palpation
  • Auscultation – decreased air sounds
    • If tension pneumothorax: hypotension, distended neck veins, no breath sounds, hyperinflation, tracheal deviation, CP, increased work of breathing
      • Place a 14 gauge needle in 2nd IC space midclavicular line (above 3rd rib)

Placing a chest tube

  • Clean area
  • Lidocaine freezing
  • Incision above 6th rib in 5th IC (or 4th IC) space along anterior axillary line
  • Bluntly dissect down with Kelly’s
  • May use more freezing once intercostals are visible (block intercostals nerves)
  • Pop through pleura and spread with Kelly’s and feel with finger
  • Place a 32 french CT using Kelly’s directed superiorly and posteriorly
  • Attach to under water seal suction at 20 mmH2O
  • Check patient’s tetanus status –> treat if appropriate

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