Tension pneumothorax: Lateral needle decompression

Abstract

A 37 yo man presented to the ED with sudden onset of left sided chest pain and dyspnea after lifting a box. On physical examination the patient was hypotensive (86/55), tachycardiac (HR 125), hypoxic (88%), diaphoretic, with diminished left sided breath sounds. A portable chest x-ray revealed a large left tension pneumothorax with rightward tracheal deviation and mediastinal shift. (Image 1) The patient was placed on oxygen and an emergent needle decompression thoracostomy was performed. A 14-gauge needle was placed into the lateral 4th intercostal space at the mid-axillary line with immediate return of air and improvement in vital signs and symptoms. The needle was then used as a guide for placement of a percutaneous chest tube via the Seldinger technique. (Total procedure time was < 4 min.) A chest x-ray showed re-expansion of the left lung with the chest tube. (Image 2) The patient was admitted to the pulmonary service in stable condition.