EMERGENCY THORA CENTESIS

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Prof. T.K.Parthasarathy

Indications :

Tension Pneumothorax

Massive Pneumothorax

Problem:

When air leak occurs inside pleural cavity from the lung there is no escape for it

and air builds up inside the pleural cavity causing pressure and collapse of the lungs pushing the mediastinum and trachea to the other side. It further decreases the venous return and compresses the opposite lung also leading to death.

Causes:

1. Chest wall injury-rib fractures

2. Ruptured emphysematous bullae

3. Patient on mechanical ventilation (Peep)

Signs & symptoms:

  • Dyspnea - at times gasping

  • Tachycardia with hypotension

  • Tracheal deviation to the other side

  • Hyperresonance on percussion and absent breath sounds on the side of pneumothorax

  • Distended neck veins

  • Cyanosis

Usually no time for x-ray

Objective

Rapidly introduce a needle with a syringe into the pleural cavity and withdraw free pleural air to reduce tension and preserve life.

Procedure has to be followed by placement of intercostal chest tube drainage for continued decompression of the pleural cavity and keep the lungs expanded.

Requirements:

18 gauge needle with 20-50 cc syringe

Procedure:

Rapidity is essential - patient in supine position

Quick skin prep as for hypodermic injections.

The needle attached to a syringe is _ inserted into the affected pleural cavity _ in the 2nd or 3rd Inter Costal Space in midclavicular line. If tension is present the pleural air pressure will push out the plunger of the syringe forcibly. Further aspiration of air is carried out till patient is comfortably breathing and the life threatening situation is averted.

A chest tube is then inserted in the 5th Inter Costal Space at the midclavicular line for continued decompression of pleural cavity (see chest tube insertion).

1. Tension pneumothroax is a bed side clinical diagnosis

2. Do not wait for x-ray

3. Prompt use of simple needle and syringe can be life saving

4. Always follow this with Inter Costal Chest tube drainage.

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