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What I‘ve learned and heard is that if there is an indication of a tension pneumothorax (e.g. rib series fracture with elevated pulse and difficulties in breathing), treatment is always to get two venous catheters, two syringes and do needle chest compression on both sides (just to be sure the punctuation works).

I‘ve come across this article and was wondering if there are any reliable alternatives to the rather invasive treatment option, especially with the morbidity outlined in the article.

Obviously, if the indications are clear there is no reason to hesitate, but especially with children their bones are not strong and such symptoms and indications are easily achieved. I don’t want to have to pierce them, but I also don’t want to let them die.

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  • What would constitute an acceptable level of practice for a technique to be an alternative. Written into a standard level of care? You outline everything I've ever seen in your first paragraph, but I'll poke around as I have time today.
    – Atl LED
    Nov 29 '17 at 16:38
  • @AtlLED Well, are there any other options recommended than needle pain compression? If you can find a guideline saying needle chest compression is the only option, I‘m fine with that as well :) Thanks in advance!
    – Narusan
    Nov 29 '17 at 16:40
  • I mean I found a few protocols that only list that option in the treatment, but that doesn't mean that it's exclusive. I haven't been in the field in a while though, and I'm going to keep poking around. If there is an alternative the scope is definitely going to have to be in a hospital, I can't see a way for a field medic to expand their practice.
    – Atl LED
    Nov 29 '17 at 17:11
  • @AtlLED All resources I checked Hint that NCC is the only option. Feel free to post that as an answer so that someone gets the benefit of my bounty :)
    – Narusan
    Nov 30 '17 at 12:55
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    So hard to prove a negative... I'll try to get something up tomorrow night when I'm babysitting M4's.
    – Atl LED
    Nov 30 '17 at 15:26
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Tension pneumothorax is an emergency in that it an kill somebody quickly. Venous catheters are part of standard management in trauma or resuscitation settings.

As for pneumothorax itself; keep in mind that the needle decompression is not actually a definitive treatment but rather something to buy you time to do something more definitive like a tube thoracostomy.

If you read the article carefully, you can see that those recommendations are in a prehospital setting for a patient that will essentially die if you don't do something right away.

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    I think this is a good answer but it lacks supporting references.
    – Carey Gregory
    Nov 18 '20 at 15:31
  • I didn't add any because I see it as essentially just commenting on the article posted by the asker themselves. Will look for some I can add when I got some time; alternatively, if somebody thinks I'm wrong (or wants to add some themselves before I can get to it) by all means go ahead. Nov 19 '20 at 11:36
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It is treated surgically only. that disease has a high lethality. Thoracotomy may be a life-saving option if other actions fail http://www.trauma.org/archive/thoracic/CHESTtension.html

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    What do you refer to as “surgically only”? I wouldn’t consider Needle-Chest-Compression as surgical... Chest Drain Placement is listed on the source you linked to, so there definitely are other treatment options than needle thoracostomy.
    – Narusan
    Oct 31 '17 at 17:38
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    @Narusan Needle thoracostomy is only a temporizing measure. Thoracostomy (either open or percutaneous) is the definitive therapy. All of these are surgical therapies. There is no non-surgical therapy for tension pneumothorax.
    – RudyB
    Apr 9 '20 at 13:32

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