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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

INSERTION OF CHEST DRAIN

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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

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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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