INDICATIONS FOR CHEST DECOMPRESSION
Signs and Symptoms
- Absent or diminished breath sounds on one side
- Evidence of chest trauma or rib fracture
- Open or "sucking" chest wound
Diagnoses
- Pneumothorax
- Tension pneumothorax
- Hemothorax
- Hemo-pnemothorax
OPEN CHEST WOUND
- "Sucking" sound
- Requires very prompt treatment Apply an occlusive "plastic pack" dressing to wound, tape down on three sides, leaving one side open for air to escape
- Place a chest drain
- Never insert chest tube through wound
- Give high flow oxygen
- Give antibiotics
- Debride wound and consider closure
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TENSION PNEUMOTHORAX
- Air from lung puncture enters pleural space, cannot escape
- Progressive increase in intrathoracic pressure causes mediastinal shift and hypotension due to reduced venous return
- Patient becomes short of breath and hypoxic
- Diminished breath sounds on side of pneumothorax
- Requires urgent needle decompression, then chest drain as soon as possible
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TENSION PNEUMOTHORAX
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- Give high flow oxygen
- After aseptic skin preparation
- Insert a large bore needle over rib:
- 2nd intercostal space
- Over 3rd rib at mid-clavicular line
- Listen for hissing sound of air escaping
- Insert chest drain
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INSERTION OF CHEST DRAIN
Mark incision just above rib in mid-axillary line; use nipple as a landmark so incision not too low (A)
Prepare area with antiseptic; inject local anaesthetic in area of incision down to pleura
Make small transverse incision just above rib to avoid vascular injury; (A, B)
Using a pair of large curved artery forceps, go over top of rib, penetrate pleura bluntly, enlarge opening (C, D)
Insertion of Chest Drain and Underwater Seal Drainage
 
Use same forceps, grasp tube at tip, introduce into chest (E), advancing tube well past holes at end of tube
Close incision with interrupted skin sutures; use one stitch to anchor tube in place (F)
Leave additional stitch untied adjacent to tube for closing wound after tube removal (G)
Apply gauze dressing
Connect tube to underwater-seal drainage system, mark initial level of fluid in drainage bottle (G)
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