Tension Pneumothorax

Finger Thoracostomy (preferred in ED where expertise available)

• Site: 5th intercostal space, just anterior to the mid-axillary line (“safe triangle”)
• Rationale:
  • More reliable than needle decompression
  • Not limited by catheter length or kinking
  • Allows immediate progression to chest drain insertion
• Advantages:
  • Lower failure rates than needle decompression
  • Avoids catheter dislodgement
• Indications:
  • Peri-arrest / ventilated patients
  • Strong clinical suspicion with haemodynamic compromise
  • When trained personnel available

Needle Decompression

• Still appropriate in:
  • Prehospital setting
  • Early resuscitation when thoracostomy not immediately feasible
• Sites:
  • 2nd intercostal space, midclavicular line; OR
  • 4th/5th intercostal space, just anterior or mid-axillary line
• Key Points:
  • Both sites are acceptable; site selection should consider patient body habitus
  • Lateral site often preferred due to:
    • Thinner chest wall in many patients
    • Easier landmarking and better stability
  • In obesity, anterior site may be more reliable
• Limitations:
  • Standard 14G cannulas (45mm) frequently fail
  • Use longer catheters (≥70mm) where available