What is included in prehospital care for tension pneumothorax?

Updated: Apr 28, 2020
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

Failure of the emergency medical service personnel (EMS) and medical control physician to make a correct diagnosis of tension pneumothorax and to promptly perform needle decompression in the prehospital setting can result in rapid clinical deterioration and cardiac arrest. Most paramedics are trained and protocolized to perform needle decompression for immediate relief of a tension pneumothorax.

However, if an incorrect diagnosis of tension pneumothorax is made in the prehospital setting, the patient's life may be endangered by unnecessary invasive procedures. Close cooperation and accurate communication between the ED and the EMS personnel is of paramount importance.

To prevent reentry of air into the pleural cavity after needle thoracostomy and decompression in the prehospital setting, a one-way valve should be attached to the distal end of the Angiocath. If available, a Heimlich valve may be used. If a commercially prepared valve is not available, attach a finger condom or the finger of a rubber glove with its tip removed to serve as a makeshift one-way valve device.

Clothing covering a wound that communicates with the chest cavity can play a role in producing a one-way valve effect, allowing air to enter the pleural cavity but hindering its exit. Removing such clothing items from the wound may facilitate decompression of a tension pneumothorax.

A tension pneumothorax is a contraindication to the use of military antishock trousers.


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