Table of Contents Needle thoracostomy procedureSubsequent management What is a tension pneumothorax? Progressive accumulation of air within the pleural space, usually due to a laceration which allows air to enter the pleural space but not return. This results in increasing pressure on the mediastinum which shifts to the opposite side, compresses major vessels and can cause circulatory compromise and cardiac arrest. Signs of a tension pneumothorax: Respiratory distressTachycardia, hypotension, hypoxiaTracheal deviation to opposite sideOn affected sideIncreased percussion noteAbsent breath sounds Needle thoracostomy procedure Confirm side as aboveApply sterile glovesSterilise area with chlorhexidine snap-swab or equivalentObtain a 14-16G (orange/grey) IV cannula and attach a 10ml syringe to the back portInsert into the second intercostal space, mid-clavicular line at 90Ëš, just above the 3rd rib (to avoid the neurovascular bundle on the inferior rib surface of the 2nd rib above)Aspirate as you advance and continue advancing until air can be aspirated into the syringeAfter air is aspirated, keeping the needle still, advance the cannula body until it reaches the skin (keeping the needle/syringe still)Remove the needle and syringeSecure with tape Wide-bore cannula with syringe Subsequent management The tension pneumothorax has now been converted into a simple pneumothoraxA chest drain is required for definitive management